Ford, Sarah Theresa; (2002) Analysing doctor-patient interactions in oncology: The development of the medical interaction process system (MIPS). Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

In recent years the demand for communication skills training for doctors has increased. Therefore, there is a greater need for reliable methods of evaluating medical interview teaching programmes and the models from which they derive. The analysis of video and audio taped consultations, using systems of interaction analysis, is an effective method for assessing changes in doctors' communication skills after training. Interaction analysis can provide trainees with in-depth feedback on their interviewing techniques and has been used to investigate the effect of interactive behaviours on patients' health care outcomes. Most interaction systems were designed for use in primary care or general practice and recent research has cast doubt on their suitability for analysing consultations in other medical specialties such as oncology. Consultations in oncology, particularly those characterised by bad news, involve the conveyance of complex and often distressing information by clinicians to patients. Evidence exists that oncologists who have effective communication skills can reduce patients' feelings of anxiety and uncertainty in the short term and also improve long term psychological adjustment. Therefore, medical communication skills training and evaluation is important. The few existing systems specifically designed for evaluating interactions in oncology tend to be time consuming to apply and/or devoid of detailed communication skill and information categories. This thesis describes the development of a new instrument, the Medical Interaction Process System (MIPS) for use in teaching communication skills and empirical research in medical encounters between doctors and patients, particularly those with cancer. A detailed account is given of how the behaviour categories and coding methods were developed. This is followed by a description of the methods used to assess the reliability and validity of the new system. Finally, there is a discussion of the strengths and weaknesses of the research, how it links with earlier studies and recommendations for future research.

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