Thompson, Jemima;
(2025)
The development of a conceptual framework and method to determine whether doctors’ responses to patients’ concerns are patient-centred.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
Introduction Patient-centred communication is a key process in patient-centred care. Epstein et al propose four domains of patient-centred communication, which guide this thesis: 1) eliciting and understanding patients’ perspectives, including needs and concerns, 2) understanding patients within their psychosocial context, 3) reaching a shared understanding of the problem and its treatment, concordant with patient values, and 4) promoting shared power and responsibility by involving patients in choices, providing a structured approach to analysing how doctors engage with patient concerns. Patient-centred communication is associated with improved health outcomes, making it a core focus in medical education. However, its measurement faces conceptual and methodological challenges. This study aimed to address these challenges by developing a conceptual framework and using a combination of methods to examine doctors’ responses to patients’ concerns. Methods An observational study analysed 78 simulated consultations by physicians participating in a postgraduate examination. Epstein et al’s four domains guided the analysis. Concerns and responses were identified using Verona Coding Definitions of Emotional Sequences (VR-CoDES) and Sequential Analysis. VR-CoDES categorised responses, whilst Next-turn proof procedure assessed alignment between patients’ reactions to responses. Frequencies and timings of responses were also examined. Results A conceptual framework, the concern narrative, was developed, and a considerable amount of concern and response talk identified. Variations were found in how concerns were solicited, formulated, and expressed between consultations. VR-CoDES captured nuances in how doctors’ responses were formulated and how they functioned. Next-turn proof procedure showed that simulated patients’ reactions to doctors’ responses often aligned with how responses were perceived to function based on their VR-CoDES categorisation. Differences were observed in frequency and distribution of response types throughout consultations. Discussion This study highlights the importance of contextual information; formulation, timing, frequency and sequential positioning, in measuring patient-centred communication. Findings potentially address conceptual and methodological gaps in its teaching and assessment.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | The development of a conceptual framework and method to determine whether doctors’ responses to patients’ concerns are patient-centred |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2025. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10205558 |
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