title: A microanalysis of the clarity of information in physicians' and patients' discussions of treatment plans with and without language barriers.
abstract: OBJECTIVE
  Physicians and patients discuss treatment plans. If tasks within plans are not described adequately, patients cannot adhere. We evaluated task descriptions, testing whether patient engagement and language barriers affected task clarity.
  
  
  METHODS
  We sampled 12 videotaped hospital interactions from a corpus of 497: two encounters each from six hospital physicians, interacting with one native-speaking and one non-native-speaking patient. We used microanalysis of face-to-face dialogue to assess whether the physicians and patients achieved a complete, clear description of each task's three core information elements (who should do what and when).
  
  
  RESULTS
  We conducted detailed analysis on 78 of the 90 tasks. Core information elements were complete in 62 (0.79) and clear in 37 (0.47). Language barriers had no effect on task clarity. When native-speaking patients were engaged, tasks were clearer (p<0.05). Although non-native-speaking patients were significantly more engaged (p<0.01), their engagement had no effect.
  
  
  CONCLUSIONS
  Physicians may be pursuing patients' agreement, motivation, and commitment at the expense of working with the patient to be clear about what needs to be done.
  
  
  CONCLUSIONS
  Physicians need to improve how clearly they present basic task information. Previous research demonstrated that even a short course can significantly improve the clarity of instructions.
authors.affiliation: Health Services Research Center (HØKH), Akershus University Hospital, Lørenskog, Norway. Electronic address: jennifer.gerwing@gmail.com.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gerwing
authors.affiliation: Norwegian Center for Minority Health Research (NAKMI), Oslo Universitetssykehus HF, avd. Ullevål, Oslo, Norway. Electronic address: thor.indseth@nakmi.no.
authors.forename: Thor
authors.initials: T
authors.lastname: Indseth
authors.affiliation: Health Services Research Center (HØKH), Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, Campus Ahus, University of Oslo, Norway. Electronic address: pal.gulbrandsen@medisin.uio.no.
authors.forename: Pål
authors.initials: P
authors.lastname: Gulbrandsen
mesh_terms: D000328:Adult; D003144:Communication Barriers; D005260:Female; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D010349:Patient Compliance; D010358:Patient Participation; D010817:Physician-Patient Relations; D010820:Physicians; D014743:Videotape Recording
keywords: Doctor–patient communication; Language barriers; Patient adherence; Patient participation; Treatment decisions