title: Discussions about preventive services: a qualitative study.
abstract: BACKGROUND
  Elderly minority patients are less likely to receive influenza vaccination and colorectal cancer screening than are other patients. Communication between primary care providers (PCPs) and patients may affect service receipt.
  
  
  METHODS
  Encounters between 7 PCPs and 18 elderly patients were observed and audiotaped at 2 community health centers. Three investigators coded transcribed audiotapes and field notes. We used qualitative analysis to identify specific potential barriers to completion of preventive services and to highlight examples of how physicians used patient-centered communication and other facilitation strategies to overcome those barriers.
  
  
  RESULTS
  Sharing of power and responsibility, the use of empathy, and treating the patient like a person were all important communication strategies which seemed to help address barriers to vaccination and colonoscopy. Other potential facilitators of receipt of influenza vaccine included (1) cultural competence, (2) PCP introduction of the discussion, (3) persistence of the PCP (revisiting the topic throughout the visit), (4) rapport and trust between the patient and PCP, and (5) PCP vaccination of the patient. PCP persistence as well as rapport and trust also appeared to facilitate receipt of colorectal cancer screening.
  
  
  CONCLUSIONS
  Several communications strategies appeared to facilitate PCP communications with older patients to promote acceptance of flu vaccination and colorectal cancer screening. These strategies should be studied with larger samples to determine which are most predictive of compliance with prevention recommendations.
authors.affiliation: Department of Medicine, Cambridge Health Alliance and Harvard Medical School, Cambridge, MA, USA. klasser@challiance.org
authors.forename: Karen E
authors.initials: KE
authors.lastname: Lasser
authors.forename: Bridget
authors.initials: B
authors.lastname: Kelly
authors.forename: Jan
authors.initials: J
authors.lastname: Maier
authors.forename: Jennifer
authors.initials: J
authors.lastname: Murillo
authors.forename: Sonia
authors.initials: S
authors.lastname: Hoover
authors.forename: Karen
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authors.lastname: Isenberg
authors.forename: Deborah
authors.initials: D
authors.lastname: Osber
authors.forename: Natasha
authors.initials: N
authors.lastname: Pilkauskas
authors.forename: Bayo C
authors.initials: BC
authors.lastname: Willis
authors.forename: James
authors.initials: J
authors.lastname: Hersey