Article Figures & Data
Tables
- Table 1.
Conversation Analysis Example Including Coded Actions from a Segment of an Annual Wellness Visit
Time Anchor (Time Stamp) Characterization of Action (What Is Accomplished via Communication) Packaging of Action (How Messages Are Communicated) Potential Implications of Action (Impact on Decision Making or Goal Setting) Talk Type 10:00 Doctor emphasizes that smoking cessation will give most health benefit for this patient Professional authoritative statements invoking evidence Patient may be more likely to take steps to quit smoking when the message comes from the doctor Advice 10:30 Doctor asks how much patient is smoking a day Respectful and tactful initiation of topic Getting overall idea of patient's desire to quit, if any 11:00 Patient says smoking cessation is not a goal for him currently; doctor asks him to elaborate Doctor uses motivational interviewing techniques to elicit thinking about behavior Patient reflects on why quitting smoking is not a current priority Change talk 11:30 Patient inquires about benefits of switching to “healthier” cigarettes/vaping “I am not ready yet to jump, but perhaps in steps…” Patient education and moving patient along the continuum of change Change talk 12:00 Doctor explains research findings, encourages patient to make that small change Skillful guidance in synergy with authority Patient education, encouragement to take small steps toward quitting smoking (toward a SMART goal) Change talk 12:30 Doctor and patient talk about increasing the amount of sleep prompted by HRA recommendation Doctor “negotiates” with patient about what a reasonable goal would be in terms of hours/night Goal setting; doctor and patient agree on 6.5 hours/night Goal setting 13:00 Doctor encourages patient to follow the links on the wellness portal to receive more education Effective “time-saving” approach leveraging technology/info patient already has access to Patient may use wellness portal resources to make more successful lifestyle changes Advice 13:30 Doctor and patient talk about how to modify response to stress in patient's life Empathy and personal reassurance of understanding Patient is encouraged to change response to stress in an understanding environment Change talk 14:00 Doctor makes recommendations on how to respond to stress Coaching/facilitative tone Patient receives specific strategies for coping with stress Advice HRA, health risk assessment; SMART, Specific-Measurable-Achievable-Realistic-Time-Bound.
- Table 2.
Conversation Analysis Example Including Coded “Turns” from a Segment of an Annual Wellness Visit
Conversation Unit (Turn Sequence Number) How Turn Was Obtained Who Speaks How Long They Speak (Approximately, in Seconds) Cutting Into Talk Notes 143 Response Patient 5 Introducing smoking cessation topic 144 Question Clinician 2 Yes 145 Response Patient 3 151 Response Patient 1 “So what I'm hearing is that stopping smoking is not a goal.” 152 Question Clinician 7 153 Response Patient 2 159 Question/Response Patient/Clinician 1 Yes “What kind of cigarettes can I smoke?” 160 Response Clinician 5 161 Question Patient 12 A “turn” is a natural conversation unit during which a specific speaker “has the ball.”
- Table 3.
Characteristics of Covariates That Were Used to Match Annual Wellness Visits Before and After the Intervention
Study Phase Clinicians and Visits (n) Location of Visits Talk Time (seconds) Number of Turns Patient Age (years), mean ± SD Female patients (%) Nonwhite Race (%) AWVs before intervention Dr. A, 4 visits Clinic A 9976 (total) 1179 (total) 50 ± 18 81 45 Dr. B, 2 visits Clinic B 906 ± 271 (per visit) 107 ± 57 (per visit) Dr. C, 5 visits Clinic C AWVs after intervention Dr. A, 4 visits Clinic A 9882 (total) 1320 (total) 54 ± 13 72 54 Dr. B, 2 visits Clinic B 898 ± 395 (per visit) 120 ± 50 (per visit) Dr. C, 5 visits Clinic C Difference NS NS NS NS NS NS (P = .65) NS (P = .69) AWV, annual wellness visit; NS, not significant; SD, standard deviation.
- Table 4.
Explanations of Five Notable “Talk Types” Derived from Patient-Clinician Conversations Recorded During Annual Wellness Visits
Annual Wellness Visit Talk Type Talk Type Definition Examples from Annual Wellness Visit Recordings Change talk Verbalization of the intent of or strategies for changing health behavior (by patient or clinician) Patient: “Do you think it would be healthier if I switched from cigarettes to vaping?”
Clinician: “Well, vaping still carries health risks, but it may be a step for you in the right direction.”Goal-setting talk Discussion of specific (short or long-term) goals for changing behavior (by patient or clinician) Clinician: “So, what I am hearing is that you could increase your sleep time by about an hour, so you could sleep at least 6|n$ hours every night? Could you start maybe next week?”
Patient: “Yes, I think I could do that.”Education talk Providing more in-depth patient education (eg, explaining mechanisms) Clinician: “Physical activity has been shown to improve steadiness and balance by strengthening our muscles and helping us better feel our movements as we walk. This can also help prevent falls.” Advice talk Providing specific and focused suggestions or recommendations (without further explanation) Clinician: “I encourage you to do the things we have discussed and you said you would do, so we can get your blood sugar under control. I am afraid that if we can't get your sugar under control, you may have to go on insulin.” Prescriptive talk Clinicians simply tell patients what to do without much discussion or explanation Clinician: “You really need to see the nutritionist! When we are finished, I am going to go ahead and put in a referral.” Clinician: “Your pneumonia shot is due today; I will ask the nurse to give you the shot before you leave.”
