The presence of companions during emergency department evaluation and its impact on perceptions of clinician-patient communication

Abstract

Objectives: Research in outpatient setting suggests that the presence of companions during a medical encounter can improve clinician-patient communication. It is not known if the presence of companions has a similar effect in the acutely stressful context of the ED. This study tested whether the presence of companions in the ED relate to stronger clinician-patient communication. We further explored effect modification by demographic factors (race/ethnicity, education and language) thought to compromise communication.

Methods: Participants were drawn from an observational cohort study of patients with suspected acute coronary syndrome (n=876) recruited from an urban academic medical centre between 2013 and 2016. Patient interviews occurred both in the ED and post-ED discharge; communication was assessed using the Interpersonal Processes of Care Survey with possible range of scores of 14-70. Companions were categorised as close others (ie, partner/spouse or child), non-close others (eg, neighbour) or no one.

Results: Perceptions of clinician-patient communication were high (mean=57.1, SD=10.6;). There was no association between companions (close/non-close/no one) and clinician-patient communication, p=0.262. Demographic factors were unrelated to communication. There was a significant interaction between education and companions. Having a close other in the ED was associated with stronger clinician-patient communication only for patients with high school education or less, p=0.027.

Conclusions: Neither the presence of companions nor demographic factors were related to clinician-patient communication. The interaction effect suggesting that patients completing high school or less have the most to gain from the presence of close others warrants further exploration.

Keywords: cardiac care, acute coronary syndrome; clinical care; emergency department; interpersonal.

Figure 1.

Patient ratings of doctor-patient communication separated by education and presence/type of others in in the emergency department during evaluation for acute coronary syndrome. Participants with High School or Less reported significantly stronger clinician-patient communication when Close Others were present (vs. both No One and Non-Close Others). There were no significant differences for those with No One, Close Others, or Non-Close Others in the Emergency Department for participants with Trade School/Some College or for participants with a College or Graduate Degree.