Health literacy and quality of physician-trauma patient communication: Opportunity for improvement

BACKGROUND Although physician-patient communication and health literacy (HL) have been studied in diverse patient groups, there has been little focus on trauma patients. A quality improvement project was undertaken at our Level I trauma center to improve patient perception of physician-patient communication, with consideration of the effect of HL. We report the first phase of this project, namely the reference level of satisfaction with physician-patient communication as measured by levels of interpersonal care among patients at an urban Level I trauma center. METHODS Level I trauma center patients were interviewed during hospitalization (August 2016 to January 2017). Short Assessment of Health Literacy tool was used to stratify subjects by deficient versus adequate HL. Interpersonal Processes of Care survey was administered to assess perception of physician-patient communication. This survey allowed patients to rate physician-patient interaction across six domains: clarity, elicited concerns, explained results, worked together (on decision making), compassion and respect, and lack of discrimination by race/ethnicity. Each is scored on a five-point scale. Frequencies of top-box (5/5) scores were compared for significance (p < 0.05) between HL-deficient and HL-adequate patients. RESULTS One hundred ninety-nine patients participated. Average age was 42 years, 33% female. Forty-nine (25%) patients had deficient HL. The majority of patients in both groups rated communication below 5/5 across all domains except compassion and respect and lack of discrimination by race/ethnicity. Health literacy-deficient patients were consistently less likely to give physicians top-box scores, most notably in the elicited concerns domain (35% vs. 54%, p = 0.012). CONCLUSION Health literacy-deficient patients appear relatively less satisfied with physician communication, particularly with respect to perceiving that their concerns are being heard. Overall, however, the majority of patients in both groups were unlikely to score physician communication in the top box. Efforts to improve physician-trauma patient communication are warranted, with attention directed toward meeting the needs of HL-deficient patients. LEVEL OF EVIDENCE Prognostic/Epidemiologic, level I.