Background/Purpose:

Systemic sclerosis is a potentially life-threatening, clinically diverse, and rare condition. The prognosis and course of disease is difficult to predict and treatment is complex. This can be challenging to understand or explain, posing challenges for effective physician-patient communication. Our study explored communication between physicians and patients with SSc-ILD to assess communication and understanding and identify information gaps and needs.

Methods:

23 20-minute consultations between physicians (rheumatologists, pulmonologists) and patients (19 real, 4 actors) with diagnosed SSc-ILD across 5 countries were directly observed and video/audio recorded. SSc-ILD (limited/diffuse) of all severities, with a range of other organ involvement, was represented. None of the discussants were known to one another. Consultations were analysed using linguistic techniques based on interactional sociolinguistic discourse analysis to understand the pattern and meaning of communication, whether the needs of both participants were met, and the level of understanding between participants.

Results:

The following issues inhibited effective communication between patients and physicians:

1. 1. Consultation pattern: In most consultations, patients were given little opportunity to explain their concerns or ask questions. Physicians solicited the patient’s story but quickly diverted it to extract clinical information. During effective consultations, patients were invited to tell their story, guided by physicians, who also gathered clinical information. Physicians used techniques to check and demonstrate understanding, express empathy and build rapport.

1. 2. Use and meaning of language: Physicians used plain language in their explanations but often reverted to medical terminology when the issue became complex. Patients often used medical terminology with limited understanding of the terms. Hence, some physicians mistakenly believed patients had a better understanding than they actually had.

1. 3. Cognitive models: Physicians and patients had different ways of understanding SSc-ILD based on their knowledge, experiences, expectations and beliefs. This determined what information patients shared and how they interpreted information from physicians. Differences in cognitive models between patients and physicians were responsible for misunderstandings.

Conclusion:

Communication challenges between patients and physicians limit joint understanding of SSc-ILD and may result in both parties missing important information and patients being less aware of self-help management approaches. Strategies should be developed with physicians to facilitate effective communication and increase patient understanding and support.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/divided-by-a-common-language-challenges-in-physician-patient-communication-limit-patient-understanding-and-support-in-systemic-sclerosis-with-interstitial-lung-disease-ssc-ild/