COMMUNICATION IN THE DOCTOR-PATIENT RELATIONSHIP: PERCEPTIONS OF THE OLDER ADULT (LOW SES, INSTRUMENT DESIGNED).

Abstract

The general purpose of this study was to ascertain how older adults want their physicians to communicate with them and behave toward them. The first objective was to develop an instrument to measure attitudes toward communication in the doctor-patient relationship, the Physician-Patient Communication Inventory (PPCI). The second objective was to investigate age differences among older adults in specific aspects of the doctor-patient relationship. Six forms were administered to 54 women and 6 men aged 60-91: Consent form, Subject Data Form, Known Doctor Behavior List (PPCI, Part I), Ideal Doctor Behavior List (PPCI, Part II), Rokeach Dogmatism Scale (short form), and an open-ended request for additional comments. Statistical analyses included varimax-rotated factor analyses, split-half reliabilities, divergent validity, frequency tabulations, Pearson product-moment correlations, and multiple analyses of variance. Results indicated that the PPCI is a reliable instrument containing nine factors which relate to the content and style of physician communication with patients. The particular importance for physicians to have medical knowledge and to be able to communicate is clear from both parts of the PPCI. Low correlations with the Rokeach Dogmatism Scale showed that the PPCI does not measure general authoritarianism and intolerance. Comparisons between subjects aged 60-74 and subjects 75-91 did not yield significant differences at the .05 level, although the results on the Known Doctor Behavior List Factor 3, Dissatisfaction with Doctors, indicated a slight preference in adults aged 60-74 for taking the active role of the consumer, rather than accepting an authoritarian physician (P < .09). Results reported on individual PPCI items indicated that the older adults did not want family involvement in diagnosis and treatment of their health problems. Responses to terminal illness issues were mixed, as were responses to physician responsibility in non-medical problems. Recommendations included (1) repeating this study using a larger sample size, extreme groups, groups varying on demographic variables, and groups of illness-alike subjects; (2) exploring reasons that lead to patient termination of the doctor-patient relationship; and (3) investigating preferences of older adults in family involvement, communication about terminal illness, and physician responsibility in non-medical problems.