Researchers are increasingly aware of the influence of communication in mediating patient treatment decisions [1]. Patient-physician communication has been examined through a variety of methods [2]. Researchers are moving towards videotape-based analyses, arguing that video is the only medium capable of capturing the full range of behaviors involved in interactions [3].

Most coding systems provide a static view of the interaction, relying on frequency counts and global ratings. As models of health-related interactions among providers and patients become better developed, however, the need for more sophisticated sequential process analysis increases.

The Observer Video-Pro allows researchers to efficiently examine observational data sequentially, offers flexible coding and analysis and reduces error. Advantages of The Observer Video-Pro system seem obvious, yet empirical evidence of the value added has not been clearly documented. Our goal is to demonstrate the benefits of using The Observer system over traditional paper and pencil scoring using a patient-physician communication assessment instrument, the Moffitt Accrual Analysis System (MAAS).

Participants
Participants include 47 patients at H. Lee Moffitt Cancer Center (approximately 25% male, 75% female, average age 58 years) and 12 medical oncologists (2 female, 10 male). Data are based on 47 videotaped physician-patient interactions.

Measure
Moffitt Accrual Analysis System (MAAS [1]). This observational behavior coding system is designed for coding relevant communication behaviors occurring between oncologists and patients during oncology consultations, in which patients are presented with clinical trial treatment options. The MAAS contains a set of global subjective ratings, assessing three dimensions of patient-physician communication behavior, and a behavioral checklist assessing physician legal/informational messages, as well as social support messages.

Procedure
Data have been collected and are currently being coded and analyzed. Videotaped interactions are coded by multiple raters using the MAAS under two conditions: (1) using traditional paper and pencil; and (2) using The Observer Video-Pro computer-based coding.

Analysis
Hypothesis 1: Intra-class correlations reflecting the degree of agreement between raters will be higher in The Observer condition.

Hypothesis 2: Confirmatory factor analysis on data from the two methods will yield the same factor structures representing the three MAAS dimensions, but the magnitude of loadings will vary between methods. The Observer data should account for more common variance and less error variance.

In addition to empirical comparisons of the two approaches, The Observer provides the additional value of offering efficient sequential analysis, which has not traditionally been performed. Data from the Behavioral Checklist portion of the MAAS will be used in sequential analysis.

References

1. Albrecht, T.L.; Blanchard, C.; Ruckdeschel, J.C.; Coovert, M.; Strongbow, R. (1999). Strategic physician communication and oncology clinical trials. J Clin Oncol, 17(10), 3324-3332.
2. Boon, H.; Stewart, M. (1998). Patient-physician communication assessment instruments: 1986 to 1996 in review. Patient Education and Counseling, 35, 161-176.
3. Ford, S.; Hall, A.; Ratcliffe, D.; Fallowfield, L. (2000). The Medical Interaction Process System (MIPS): an instrument for analyzing interviews of oncologists and patients with cancer. Soc Sci Med., 50(4), 553-566.

Paper presented at Measuring Behavior 2002 , 4^th International Conference on Methods and Techniques in Behavioral Research, 27-30 August 2002, Amsterdam, The Netherlands

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