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Shared understanding in psychiatrist–patient communication: Association with treatment adherence in schizophrenia

McCabe, R. ORCID: 0000-0003-2041-7383, Healey, P. G. T., Priebe, S. , Lavelle, M., Dodwell, D., Laugharne, R., Snell, A. & Bremner, S. (2013). Shared understanding in psychiatrist–patient communication: Association with treatment adherence in schizophrenia. Patient Education and Counseling, 93(1), pp. 73-79. doi: 10.1016/j.pec.2013.05.015


Effective doctor–patient communication, including a shared understanding, is associated with treatment adherence across medicine. However, communication is affected by a diagnosis of schizophrenia and reaching a shared understanding can be challenging. During conversation, people detect and deal with possible misunderstanding using a conversational process called repair. This study tested the hypothesis that more frequent repair in psychiatrist–patient communication is associated with better treatment adherence in schizophrenia.

Routine psychiatric consultations involving patients with (DSM-IV) schizophrenia or schizoaffective disorder were audio-visually recorded. Consultations were coded for repair and patients’ symptoms and insight assessed. Adherence was assessed six months later. A principal components analysis reduced the repair data for further analysis. Random effects models examined the association between repair and adherence, adjusting for symptoms, consultation length and the amount patients spoke.

138 consultations were recorded, 118 were followed up. Patients requesting clarification of the psychiatrist's talk and the clarification provided by the psychiatrist was associated with adherence six months later (OR 5.82, 95% CI 1.31–25.82, p = 0.02).

The quality of doctor–patient communication also appears to influence adherence in schizophrenia.

Practice implications
Future research should investigate how patient clarification can be encouraged among patients and facilitated by psychiatrists’ communication.

Publication Type: Article
Additional Information: © Elsevier 2013. This manuscript version is made available under the CC-BY-NC-ND 4.0 license
Publisher Keywords: Doctor–patient communication, Repair, Adherence, Antipsychotics, Schizophrenia
Subjects: B Philosophy. Psychology. Religion > BF Psychology
R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
R Medicine > RT Nursing
Departments: School of Health & Psychological Sciences > Healthcare Services Research & Management
SWORD Depositor:
[thumbnail of PEC repair revised manuscript+ tables 22.04.13.pdf]
Text - Accepted Version
Available under License Creative Commons Attribution Non-commercial No Derivatives.

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