Fine-Tuning Conversation Skills Improves Health Outcomes

What is the key element that could improve healthcare for doctors and patients around the world?  The answer is simple -communication.  Research has shown that collaborative communication between providers and patients has multiple benefits, including increased patient satisfaction, treatment adherence, and decreased rates of 30-day readmissions. For practitioners, who average approximately 250,000 patient encounters over a lifetime, collaborative communication can help reduce patient safety risks and insurance costs, while increasing their sense of effectiveness and job satisfaction. Yet an overwhelming majority of physicians have never received professional development on how to manage patient communication.

Provider-patient collaborative conversations are powerful tools to bring about change in attitudes while building life skills, knowledge, trust, and confidence. This can ultimately result in meaningful and sustained changes in health behaviors.  In a sense, this collaboration allows for clearer expectations, understanding and knowledge that can enable the doctor to better understand and meet the patients’ needs. It also can help them empower patients to assume responsibility and take steps, albeit sometimes small ones, to manage their own healthcare. This type of collaborative interaction engenders empathy and trust, all of which increase health outcomes, as well as patient and doctor satisfaction.

However, collaborative conversations surrounding health, wellness, and social issues don’t come easy for either patients or physicians. Learning to ignite and execute a meaningful conversation begins with practice. Some physicians have begun using new conversation-practicing simulations with virtual patients to make the most of their patient interactions.

These simulations provide physicians and other healthcare providers with a virtual, risk-free practice environment, where different dialogue choices and approaches in managing a challenging health conversation can be experimented. The skills addressed often include motivational interviewing, shared decision-making, and social-emotional skills such as empathy, trust, and emotional self-regulation. In addition, conversations build knowledge on specific topics and provide practice in applying specific processes, such as screening patients using validated tools or conducting a brief intervention.

Empirically-based communication strategies such as Motivation Interviewing (MI), theory of the mind (or mentalizing), and emotional regulation - all constructs shown to increase patient engagement, collaboration, and health outcomes - are important elements of any conversation-practicing solution that physicians may consider. 

MI is a goal-oriented, client-centered counseling approach designed to actively engage patients in identifying their problems and to increase their intrinsic motivation to change their behavior.  MI skills can be summarized in the acronym OARS where collaborative communication skills involve Open-ended questions, Affirmation statements, Reflecting back what the patient said and Summarizing.  When healthcare providers implement OARS, as well as ask permission to give information and advice, they build trust, empower their patients, and increase adherence to treatment. 

Mentalizing is our ability to understand and accept without judgement a patient’s own set of beliefs, understandings, and emotions about their health. This facilitates a provider’s ability to experience empathy or empathic accuracy, also known as cognitive empathy, which is knowing what the patient is feeling without experiencing it themselves. Both of these constructs can lead to better health outcomes. 

Emotional regulation in communication, particularly the use of reappraisal strategy, which involves being aware of the patient’s emotions and one’s own emotions as a physician, allows the provider to better implement MI and mentalization. 

The use of simulations with virtual humans that integrate MI, mentalizing, and emotional regulation has great promise in providing physicians the necessary collaborative communication skills to positively impact the health of their patients. This is particularly the case for those in treatment for chronic diseases, where identifying intrinsic motivators and developing patient trust and satisfaction affects treatment compliance.

From a more generalist perspective, simulations that enable users to better manage difficult or challenging health conversations offer potential landscape-changing solutions for learning sustained behavior change.  By combining recent neuroscience and social cognitive research with groundbreaking developments in simulation and gaming technology, virtual humans are poised to transform how we engage individuals and professionals in building the communication skills that are key to collaboration and better health.

Glenn Albright, a clinical psychologist and director of research at Kognito, received his Ph.D. from City University of New York in the area of experimental cognition, with concentrations in neuropsychology and applied psychophysiology. He is a former chair of the department of psychology at Baruch College.