title: Factors influencing intercultural doctor-patient communication: a realist review.
abstract: OBJECTIVE
  Due to migration, doctors see patients from different ethnic backgrounds. This causes challenges for the communication. To develop training programs for doctors in intercultural communication (ICC), it is important to know which barriers and facilitators determine the quality of ICC. This study aimed to provide an overview of the literature and to explore how ICC works.
  
  
  METHODS
  A systematic search was performed to find literature published before October 2012. The search terms used were cultural, communication, healthcare worker. A realist synthesis allowed us to use an explanatory focus to understand the interplay of communication.
  
  
  RESULTS
  In total, 145 articles met the inclusion criteria. We found ICC challenges due to language, cultural and social differences, and doctors' assumptions. The mechanisms were described as factors influencing the process of ICC and divided into objectives, core skills and specific skills. The results were synthesized in a framework for the development of training.
  
  
  CONCLUSIONS
  The quality of ICC is influenced by the context and by the mechanisms. These mechanisms translate into practical points for training, which seem to have similarities with patient-centered communication.
  
  
  CONCLUSIONS
  Training for improving ICC can be developed as an extension of the existing training for patient-centered communication.
authors.affiliation: Department of Healthcare Education, Sint Lucas Andreas hospital, Amsterdam, The Netherlands. Electronic address: emmapaternotte@gmail.com.
authors.forename: Emma
authors.initials: E
authors.lastname: Paternotte
authors.affiliation: NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands; Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands; Faculty of Health Sciences, Buskerud and Vestfold University College, Drammen, Norway. Electronic address: s.vandulmen@nivel.nl.
authors.forename: Sandra
authors.initials: S
authors.lastname: van Dulmen
authors.affiliation: Department of Healthcare Education, Sint Lucas Andreas hospital, Amsterdam, The Netherlands. Electronic address: n.vanderlee@slaz.nl.
authors.forename: Nadine
authors.initials: N
authors.lastname: van der Lee
authors.affiliation: Institute for Medical Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands. Electronic address: a.scherpbier@maastrichtuniversity.nl.
authors.forename: Albert J J A
authors.initials: AJ
authors.lastname: Scherpbier
authors.affiliation: Medical School of Sciences, Vu University Medical Center, Amsterdam, The Netherlands. Electronic address: f.scheele@slaz.nl.
authors.forename: Fedde
authors.initials: F
authors.lastname: Scheele
mesh_terms: D001291:Attitude of Health Personnel / Q000208:ethnology; D001294:Attitude to Health / Q000208:ethnology; D002983:Clinical Competence / Q000592:standards*; D003142:Communication; D054521:Cultural Competency; D018864:Cultural Diversity; D006801:Humans; D008297:Male; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D011287:Prejudice; D012945:Social Values; D013240:Stereotyping
keywords: Communication training; Interultural communication; Medical education; Patient-centered communication; Realist review; Realist synthese; Theory building