How to value patients with psychosis: An inductive study of psychiatrists’ behaviour in routine consultations.

Abstract

Valuing patients underlies good communication in psychiatry and mediates positive outcomes. The aim of this study was to (1) identify and reliably assess valuing and devaluing communicative behaviour of psychiatrists in routine consultations, and (2) explore whether valuing behaviour is associated with patient satisfaction. In an inductive study, psychiatrists’ valuing and devaluing behaviours were operationalized and identified in 100 video-recorded consultations with patients with psychosis. Inter-rater reliability of identifying these behaviours was assessed. Associations with patients’ satisfaction were explored using a mixed linear regression model. We identified 18 different valuing behaviours – e.g. seeking patient’s views and supportive statements – and four devaluing behaviours – e.g. talking over the patient and poor responding to concerns – that could be assessed with good reliability. The inter-rater reliability was high (ICC=.89). More valuing behaviour was linked to higher patient satisfaction with the communication (β=.45, CI .14 to.77, p p<.01). It was found that psychiatrists value and devalue patients through a wide range of different behaviours, on which there is agreement among different observers. The inductively developed list of valuing behaviours may be validated through the association with higher patient satisfaction. The behaviours may be used in training and supervision to enhance the valuing of patients in consultations.