April 7-9, 2022 • Hyatt Regency • Lexington, KY
Communication Strategies to Promote Comprehensive Well-being
Communication Strategies to Promote Comprehensive Well-being
Abstract: The Influence of the Physical Environment on Perceptions of Patient-Provider Communication
Patient-centered communication is a crucial component of effective patient care and has been shown to improve patient satisfaction, psychological adjustment, participation in care, and contribute to the establishment of a therapeutic relationship. An important yet understudied influence is the physical environment in which genetic counseling communication takes place. Genetic counselors routinely provide service in counseling-type and medical-type rooms. Counseling environments are characterized by office décor that facilitates discussion around a seated table, while medical environments, typical to outpatient clinics, include an exam table and separate seating. Manipulation of these environmental elements can influence patient comfort in disclosing personal information, wellbeing, and overall satisfaction with provider communication. Preliminary research has found that, qualitatively, patients express feeling pre-symptomatically pathologized when experiencing pre-test genetic counseling in medical environments and feel more comfortable in non-clinical environments. However, there is little known about how experiencing genetic counseling in one environment versus the other influences patient-provider communication. To explore whether the physical environment influences patient perceptions of communication in genetic counseling, the following hypotheses were proposed: H1: Participants will rate the counseling environment as (a) more warm, comfortable, and inviting and (b) less intimidating, medical, and cold than the medical environment. H2: Participants will rate the genetic counselor’s communication more favorably when the room is rated as (a) more warm, comfortable, and inviting and (b) less intimidating, medical, and cold. H3: Participants will rate the therapeutic relationship more favorably when the room is rated as (a) more warm, comfortable, and inviting and (b) less intimidating, medical, and cold. To explore these hypotheses, we recorded two simulated cancer genetic counseling appointments (appointments 1 and 2) in front of a greenscreen background. Videos were digitally placed in both counseling and medical environments, allowing for the exact same verbal and nonverbal communication to be presented in two different environments. This created a total of four videos: (1) appointment 1 in the counseling room, (2) appointment 1 in the medical room, (3) appointment 2 in the counseling room, and (4) appointment 2 in the medical room. 902 participants were randomly assigned to observe one of the four videos and respond to the genetic counseling session as analogue clients. Supporting H1a, participants rated the counseling room as more warm, inviting, and comfortable (all p < .001 in one-way ANOVA) than those who viewed the sessions in the medical room. Similarly, participants perceived the counseling room as less intimidating, medical, and cold (all p < .001 in one-way ANOVA), supporting H1b. Using a k-means cluster analysis we found that, regardless of which room participants viewed, participants who perceived the room as warm, inviting, and comfortable reported significantly higher ratings of the genetic counselor’s communication and the therapeutic relationship (all measures p < .001 in one-way ANOVA), supporting both H2 and H3. These results offer insight into how perceptions of the clinical environment might influence the process of genetic counseling, illustrating new avenues for improving patient-provider communication in this context.