How Exam Rooms Enhance Physicians' Patient-Centeredness

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DESCRIPTION (PROVIDED BY APPLICANT): Patient-centered communication continues to be acknowledged as a central component for a therapeutic relationship between older patients and physicians. Much of this communication is initiated, developed and sustained within the physical setting of the exam room. Yet the role of that physical setting in shaping communication has not been systematically examined. A small, preliminary study (N=8) of physician-older patient interactions indicate that physicians were more patient-centered in exam rooms with physical attributes that had the latitude to facilitate interaction. The proposed research seeks to expand this preliminary work. The specific aims of this proposal are to: 1. Pretest and revise measures of physical setting attributes and patient-centeredness developed in the preliminary study. The investigators will review 20% of the tapes independently and then collaboratively to arrive at consensus on measurement instruments. 2. Code and compile physical setting attributes and patient-centeredness separately in fifty dyadic encounters; coders blinded to the conceptual basis of the study and to each other's tasks will be used for this phase of study. 3. Analyze the data and delineate the conditions under which physical attributes of the exam room become linked with physician's patient-centeredness using qualitative method techniques. This proposed study of fifty videotapes of dyadic encounters between physicians and older patients, in their naturally occurring settings, is a secondary data analysis of a larger dataset of 489 NIA archived videotapes. This subset of data will represent both the Midwest and Southwest regions of the original sample. They will also represent three types of settings specifically, independent practice, managed care and academic settings. Further, we propose to include a mix of gender and race characteristics for both physicians and older patients. The underlying goal in selecting such a purposive sample is that it comprises a variety of clinical situations to examine our main question: Is the physical setting of the exam room a salient factor in physicians' communication with their older patients?