title: Shared understanding in psychiatrist-patient communication: association with treatment adherence in schizophrenia.
abstract: OBJECTIVE
  Effective doctor-patient communication, including a shared understanding, is associated with treatment adherence across medicine. However, communication is affected by a diagnosis of schizophrenia and reaching a shared understanding can be challenging. During conversation, people detect and deal with possible misunderstanding using a conversational process called repair. This study tested the hypothesis that more frequent repair in psychiatrist-patient communication is associated with better treatment adherence in schizophrenia.
  
  
  METHODS
  Routine psychiatric consultations involving patients with (DSM-IV) schizophrenia or schizoaffective disorder were audio-visually recorded. Consultations were coded for repair and patients' symptoms and insight assessed. Adherence was assessed six months later. A principal components analysis reduced the repair data for further analysis. Random effects models examined the association between repair and adherence, adjusting for symptoms, consultation length and the amount patients spoke.
  
  
  RESULTS
  138 consultations were recorded, 118 were followed up. Patients requesting clarification of the psychiatrist's talk and the clarification provided by the psychiatrist was associated with adherence six months later (OR 5.82, 95% CI 1.31-25.82, p=0.02).
  
  
  CONCLUSIONS
  The quality of doctor-patient communication also appears to influence adherence in schizophrenia.
  
  
  CONCLUSIONS
  Future research should investigate how patient clarification can be encouraged among patients and facilitated by psychiatrists' communication.
authors.affiliation: Unit for Social and Community Psychiatry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK. r.mccabe@qmul.ac.uk
authors.forename: Rosemarie
authors.initials: R
authors.lastname: McCabe
authors.forename: Patrick G T
authors.initials: PG
authors.lastname: Healey
authors.forename: Stefan
authors.initials: S
authors.lastname: Priebe
authors.forename: Mary
authors.initials: M
authors.lastname: Lavelle
authors.forename: David
authors.initials: D
authors.lastname: Dodwell
authors.forename: Richard
authors.initials: R
authors.lastname: Laugharne
authors.forename: Amelia
authors.initials: A
authors.lastname: Snell
authors.forename: Stephen
authors.initials: S
authors.lastname: Bremner
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D016000:Cluster Analysis; D003142:Communication; D032882:Comprehension; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010817:Physician-Patient Relations; D025341:Principal Component Analysis; D011613:Psychotherapy; D011618:Psychotic Disorders / Q000523:psychology / Q000628:therapy; D012044:Regression Analysis; D012559:Schizophrenia / Q000175:diagnosis / Q000628:therapy*; D012959:Socioeconomic Factors; D013997:Time Factors; D014741:Video Recording
chemical_list: D014150:Antipsychotic Agents
keywords: Adherence; Antipsychotics; Doctor–patient communication; Repair; Schizophrenia