Don't Beat Around the Bush! The Relationship Between Forensic Vigilance and Communication Style.

The field of forensic mental healthcare is unique in several ways. Forensic vigilance is a specialty needed by forensic mental health professionals, consisting of professional forensic psychiatric knowledge, knowledge of individual patients, environmental observations, and clinical judgment. Though communication seems to play an important role in forensic vigilance, it is still unknown which communication styles are related to forensic vigilance, if any. In the current study, we examined if certain communication styles are related to forensic vigilance by means of an online survey among forensic mental health professionals. In total 138 Dutch forensic psychiatric professionals participated in the survey. The expressive and precise communication styles positively predict forensic vigilance, while the emotional and manipulative communication styles show a negative relationship with forensic vigilance. Findings of the present study further the understanding of the construct of forensic vigilance. The findings presented here may give rise to attention for specific manners of communication in supervision and training programs. The current study represents the first effort to study the relationship between communication styles and forensic vigilance.

Bulgarian General Practitioners' Communication Styles about Child Vaccinations, Mainly Focused on Parental Decision Making in the Context of a Mandatory Immunization Schedule.

The communication practices of general practitioners in relation with vaccines have not been a topic of wide scientific interest. In this article, we outline them in the context of Bulgaria. A representative, cross-sectional, quantitative, face-to-face survey was conducted among 358 Bulgarian general practitioners in 2022 using simple random sampling. We conducted an exploratory factor analysis using questions about the role of the GPs, which measure models of communication. Based on the factor analysis, we distinguished four communication styles. They were called: active communicator, restrictive communicator, informing communicator, and strained communicator. One-way ANOVA and the T-test were carried out to explore the connections between factor scores (communication styles) and other variables. One of the most important results in the study was that the informing physician (emphasizing the choice of the parents) was the most common model in Bulgaria. This is somewhat contradictory, because of the mandatory status of most vaccines. We found connections between the communication styles and other variables-such as the type of settlement, having a hesitant parent in the practice, recommendations of non-mandatory vaccines, and experience with vaccine-preventable diseases. On the basis of the factor analysis and analysis of relationships with other variables, we reached the conclusion that in Bulgaria, hesitant parents are not sufficiently involved in active, effective communication about vaccines by GPs.

Enhancing customer satisfaction with chatbots: The influence of communication styles and consumer attachment anxiety.

Chatbots are increasingly occupying the online retailing landscape, and the volume of consumer-chatbot service interactions is exploding. Even so, it still remains unclear how chatbots should communicate with consumers to ensure positive customer service experiences and, in particular, to improve their satisfaction. A fundamental decision in this regard is the choice of a communication style, specifically, whether a social-oriented or a task-oriented communication style should be best used for chatbots. In this paper, we investigate how using a social-oriented versus task-oriented communication style can improve customer satisfaction. Two experimental studies reveal that using a social-oriented communication style boosts customer satisfaction. Warmth perception of the chatbot mediates this effect, while consumer attachment anxiety moderates these effects. Our results indicate that social-oriented communication style can be beneficial in enhancing service satisfaction for highly anxiously attached customers, but it does not work for the lowly anxiously attached. This study provides theoretical and practical implications about how to implement chatbots in service encounters.

Examining a conceptual framework of aggressive and humorous styles in science YouTube videos about climate change and vaccination.

The current study investigated how individuals process aggressive and humorous video messages communicating childhood vaccination and climate change. Employing psychological reactance, message discounting and expectancy violation, we built a theoretical model that explains the effects of communication styles on individuals' activism intentions. Two online experiments in the United States (N = 441 and N = 533) using self-created videos on the topics of childhood vaccination and climate change were conducted to examine this model. The results showed that both perceived aggressiveness and humorousness of the videos led to higher message discounting, which then resulted in stronger activism intentions. Perceived aggressiveness led to higher expectancy violation, while perceived humorousness led to lower expectancy violation, which negatively affected activism intentions. The role played by psychological reactance was inconsistent across the two contexts. The findings provide theoretical implications for understanding how individuals process aggressive and humorous communication styles, especially in relation to discussions on science issues.

Communication Styles and Attention Performance in Primary School Children.

Communication styles are the three communication patterns that result from merging the verbal elements of communication, the non-verbal elements and the paraverbal elements. The objective of this study was to test what effect different communication styles have on attention performance in primary school children. We administered the assertive behavior scale for children (CABS), the symbol digit modalities test (SDMT) and the d2 attention test to a sample of 77 participants of primary school. A statistically significant and proportional correlation was found between the assertive communication style and the total number of correct answers of the SDMT. We also found positive correlations between the assertive communication style and d2 attention test performance. Children with an assertive communication style have better attention performance than children with passive or aggressive communication styles.

Style Features in Communication of the Crews With Mission Control.

In "Content," an International Space Station (ISS) Russian segment space experiment, features of communication between the cosmonauts and the Mission Control Center (MCC) were studied using content analysis. The method is based on the concept of stress copings by Lazarus and Folkman. Differences found in the communication of cosmonauts led to assumptions about the existence of individual communication styles in routine communication between the cosmonauts and the MCC. The differences found were defined using V. Satir's classical model of communication types. The pre-dominance of three main communication styles ("computing," "blaming," and "placating," as per Satir) was found. Manifestations and features of styles are discussed, considering the effectiveness of the "computing" style for ISS-MCC communication. Cosmonauts with a pre-dominance of this communication style, mostly are stable and with good self-control. An increase of the "blaming" and the "placating" style features in the communication of cosmonauts may require adaptation of the MCC communication and additional psychological support for the cosmonauts.

Reviewer's communication style in YouTube product-review videos: does it affect channel loyalty?

Product-review videos can be a promising marketing method. The popularity of using videos as a medium for product reviews is evidenced by the number of channels that are used to provide product reviews on multiple platforms. Reviewers can use various strategies to attract wider audiences and make these audiences loyal to their channels. This study analyzes the effect of the reviewer's communication style on the audience's loyalty to the channels that provide product reviews, especially on the YouTube platform. Communication-style analysis is associated with hedonic and utilitarian motivation theory, which can be used to explain communication style effect on channel loyalty. This study uses a quantitative approach using questionnaire to obtain data. The data in this study are analyzed using covariance-based structural equation modeling in AMOS 21.0. The results show that communication styles (social-oriented and task-oriented), perceived transparency, perceived enjoyment, credibility, and channel engagement affect channel loyalty. Meanwhile, the informativeness factor does not affect channel loyalty. This paper will also discuss the theoretical and practical implications of the study.

Psychometric Properties and a Preliminary Validation Study of the Italian Brief Version of the Communication Styles Inventory (CSI-B/I).

People will typically develop a communication style that tends to be coherent with their own fundamental personality traits. The current debate on communication style acknowledges the construct of adaptive behavior as an appropriate area where to include both the strictly personal aspects and social learning and cultural assimilation, which translate into communicative style as a specific form of adaptation integrating the behavioral and personality perspectives. Due to the lack of instruments in the Italian psychometric scenario to assess communication styles, the present study included the translation and validation of the Italian short version of the Communication Styles Inventory (CSI-B/I). METHODS: The CSI-B/I was administered to a sample of 1,044 participants, while the concurrent validity was tested through a second administration to 518 participants along with the MPP (Multidimensional Personality Profile). RESULTS: Confirmatory factor analysis bore out a three-factor solution (including 18 items) with good indices of adaptation to data, e.g., χ2/df = 1.251, RMSEA = 0.027, RMSEA 90% CI = 0.008-0.040, GFI = 0.958, AGFI = 0.937, CFI = 0.983 and NFI = 0.922. The CSI-B/I allows to measure three main dimensions of the communication style: impression manipulativeness; emotionality; expressiveness. Internal consistency reliability and significant correlations with the MPP supported the concurrent validity of the tool. CONCLUSION: By virtue of its good psychometric properties, CSI-B/I represents an important addition to the assessment in multiple contexts: companies, institutions, staff selection, individual and group profile analysis, coaching, psychotherapy, counseling, career guidance.

Estilos de comunicación como predictores del estrés y el afrontamiento diádico en matrimonios puertorriqueños / Communication Styles as Stress Predictors and Dyadic Coping in Puerto Rican Marriages / Estilos de comunicação como preditores do stress e o afrontamento diádico em matrimônios porto-riquenhos

Resumen Objetivo. Evaluar la posible relación de los estilos de comunicación (positivo, negativo y reservado) con el estrés y el afrontamiento diádico en las relaciones de pareja. Método. Se empleó un estudio cuantitativo no experimental en el que participaron 121 personas casadas, seleccionadas por disponibilidad. La mayoría de los participantes estaban en su primer matrimonio, y tenían una edad promedio de 42 años. Aceptaron contestar los siguientes instrumentos: (a) inventario de estilo de comunicación marital (ECOM) y (b) escala de estrés en la relación marital. Resultados. El análisis mediante regresión múltiple evidenció que los estilos de comunicación positivo y reservado son predictores del afrontamiento diádico. Se observó también que el estilo de comunicación negativo es un predictor significativo del estrés en las relaciones de pareja. Conclusión. Se sustenta la importancia de la comunicación en las relaciones de pareja y de desarrollar estilos de comunicación positivos para afrontar las situaciones estresantes.

Abstract Objetive. To evaluate the possible relationship between the communication styles (positive, negative and reserved), stress and dyadic coping. Method. Considering this purpose, a non-experimental quantitative study was proposed in which 121 married people participated based on their availability. Most of the participants were in their first marriage, and averaged 42 years old. The participants agreed to answer the following instruments: (a) Marital Communication Style Inventory and (b) Marital Relationship Stress Scale. Results. Positive and reserved communication styles are predictors of dyadic coping. It was also observed that the negative communication style is a significant predictor of stress in relationships. Conclusion. These results support the relevance of communication in relationships and the importance of developing positive communication styles to cope with stressful situations.

Resumo Escopo. Avaliar a possível relação dos estilos de comunicação (positivo, negativo e reversado) com o stress e o afrontamento diádico nas relações de casal. Metodologia. Foi empregado um estudo quantitativo não experimental no que participaram 121 pessoas casadas, selecionadas por disponibilidade. A maioria dos participantes estavam no seu primeiro matrimonio, e tinham uma idade média de 42 anos. Aceitaram contestar os seguintes instrumentos: (a) inventário de estilo de comunicação marital (ECOM) e (b) escada de stress na relação marital. Resultados. A análise mediante regressão múltipla evidenciou que os estilos de comunicação positivo e reservado são preditores do afrontamento diádico. Foi observado também que o estilo de comunicação negativo é um preditor significativo do stress nas relações de casal. Conclusão. Foi sustentada a importância da comunicação nas relações de casal e de desenvolver estilos de comunicação positivos para afrontar as situações estressantes.

The impact of communication style on patient satisfaction.

BACKGROUND: Communication between patients and health providers influences patient satisfaction, but it is unknown whether similarity in communication styles results in higher patient satisfaction. METHODS: This study was conducted in the Smilow Cancer Hospital Breast Center. During routine follow-up visits, patients completed a Communication Styles Assessment (CSA), health survey (SF-12), Princess Margaret Hospital Satisfaction with Doctor Questionnaire, and brief demographic form. Physicians and Advanced Practice Providers were also asked to complete the CSA. Patients and providers were blinded to each other's responses. A communication styles concordance score was calculated as the Pearson correlation between 80 binary CSA items for each provider/patient pair. Factors affecting patient satisfaction scores were assessed in mixed-effects models. RESULTS: In total, 330 patients were invited to participate; of these 289 enrolled and 245 returned surveys. One hundred seventy-four completed all survey components, and 18 providers completed the CSA. Among the factors considered, physical health score (effect size = 0.0058, 95% CI 0.00051 to 0.0011, p = 0.032) and employment status (0.12, 95% CI - 0.0094 to 0.25, p = 0.069) had the greatest impact on patient satisfaction. However, patients who were not employed and less physically healthy had significantly elevated satisfaction scores when their communication style was more similar to their provider's (1.52, 95% CI 0.66 to 2.38, p = 0.0016). CONCLUSIONS: Patients who were physically healthy and employed were generally more satisfied with their care. The similarity in communication styles of patients and providers had a greater impact on patient satisfaction for patients who were less physically healthy and not employed.

Addressing transition to motherhood, guideline adherence by midwives in prenatal booking visits: Findings from video recordings.

OBJECTIVE: To assess if and how primary care midwives adhere to the guideline by addressing transition to motherhood at the first prenatal booking visit and to what extent there was a difference in addressing transition to motherhood between nulliparous and multiparous women. DESIGN: Cross-sectional observational study of video-recorded prenatal booking visits. SETTING AND PARTICIPANTS: 126 video recordings of prenatal booking visits with 18 primary care midwives in the Netherlands taking place between August 2010 and April 2011. MEASUREMENTS: Five observers assessed dichotomously if midwives addressed seven topics of transition to motherhood according to the Dutch guideline prenatal midwifery care from the Royal Dutch Organization of Midwives and used six communication techniques. Frequencies and percentages of addressing each topic and communication technique were calculated. Differences between nulliparous and multiparous women were examined with Chi-Square tests or Fischer Exact tests, were appropriate. The agreement between the five observers was quantified using Fleiss' Kappa. FINDINGS: During all visits at least one of the seven topics of transition to motherhood was addressed. The topics mother-to-infant bonding and support were addressed respectively in 2% and 16% of the visits. In almost all visits the topics desirability of the pregnancy, experience with the ultrasound examination or abdominal palpation or hearing the foetal heartbeat and practical preparation were addressed. Open questions for addressing transition to motherhood were used in 6% of the prenatal booking visits. Dutch midwives addressed transition to motherhood mostly by giving information (100%) and by using closed-ended questions (94%) and following woman's initiative (90%). Nulliparous women brought up transition to motherhood on their own initiative more often than multiparous women (97% versus 84%). For the topics 'desirability of the pregnancy 'and' practical preparations' and for conversation techniques 'giving information' and 'closed-ended questions', 100% agreement was achieved. However, the topic 'Support' had poor agreement (kappa = 0.19). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Although during every visit the transition of motherhood was addressed, the topics mother-to-infant bonding and support should get more attention. Midwives should improve adherence to the guideline by addressing transition to motherhood and by using more open questions. Furthermore, they should focus on taking the initiative to address the transition to motherhood in multiparous women themselves.

Influencia de la depresión, los estilos de comunicación y la adhesión al tratamiento sobre los niveles de glucosa en personas con diabetes / Influência da depressão, dos estilos de comunicação e da adesão ao tratamento sobre os níveis de glucose em personas com diabetes / The influence of depression, communication styles and treatment adherence on glucose levels in diabetics

Resumen El objetivo de esta investigación fue analizar la influencia de la depresión, el estilo de comunicación (asertivo, pasivo o agresivo) y la adhesión al tratamiento sobre los niveles de glucosa en la sangre en sujetos con diabetes tipo 2. Por medio de un muestreo no probabilístico de tipo propositivo se seleccionó una muestra de 278 pacientes diagnosticados con diabetes tipo 2 (mínimo 1 año de diagnóstico), con edades entre 19 y 77 años, sin amputaciones ni comorbilidad con nefropatía o retinopatía diabética. Se utilizó un tipo de investigación no experimental, con un diseño transeccional-causal. Las relaciones fueron planteadas en un diseño de ruta basado en el análisis de regresión múltiple. Como instrumentos, se emplearon los Autoinformes de Actitudes y Valores en las Interacciones Sociales (ADCAS), el Cuestionario Tridimensional para la Depresión (CTD), y el Instrumento para Medir el Estilo de Vida en Diabéticos (IMEVID) -para evaluar la adhesión al tratamiento-, todos validados en población venezolana, además de la HbAlc -para medir el nivel de glucosa-. Los resultados muestran que las correlaciones entre las variables fueron bajas (con puntuaciones entre r = -.12 y r = -.33; p < .05), a excepción de dos, que pueden ser consideradas como moderadas: depresión y comunicación asertiva, con un r -.47, p < .05; y comunicación agresiva y comunicación asertiva, con un r = -.44, p < .05. Con el análisis posterior del modelo de regresión se observó que ninguna variable fue significativa para la predicción de los niveles de glucosa. En cuanto a la adhesión al tratamiento, la variable que más aporta a la predicción es la depresión. Y, con respecto al estilo de comunicación, se observó una correlación negativa, moderada y significativa entre depresión y asertividad. No se encontró relación entre la depresión y la comunicación agresiva ni pasiva. En conclusión, solo fueron corroboradas dos de las relaciones planteadas en el análisis de ruta. Se sugiere confirmar estos hallazgos en futuras investigaciones.

Resumo O objetivo desta pesquisa foi analisar a influência da depressão, do estilo de comunicação (assertivo, passivo ou agressivo) e da adesão ao tratamento sobre os níveis de glucose no sangue em sujeitos com diabetes tipo 2. Por meio de uma amostragem não probabilística de tipo propositivo, foi selecionada uma amostra de 278 pacientes diagnosticados com diabetes tipo 2 (no mínimo um ano de diagnóstico), com idades entre 19 e 77 anos, sem amputações nem comorbidade com nefropatia ou retinopatia diabética. Utilizou-se um tipo de pesquisa não experimental com um desenho transversal-causal. As relações foram apresentadas em um desenho de rota baseado na análise de regressão múltipla. Como instrumentos, foram empregados os Autoinformes de Actitudes y Valores en las Interacciones Sociales (ADCAS), o Cuestionario Tridimensional para la Depresión (CTD) e o Instrumento para Medir el Estilo de Vida en Diabéticos (IMEVID) - para avaliar a adesão ao tratamento -, todos validados em população venezuelana, além da HbA1c - para medir o nível de glucose. Os resultados mostram que as correlações entre as variáveis foram baixas (com pontuações entre r = -.12 e r = -.33; p < .05), com exceção de duas, que podem ser consideradas como moderadas: depressão e comunicação assertiva, com um r -.47, p < .05; e comunicação agressiva e comunicação assertiva, com um r = -.44, p < .05. Com a análise posterior do modelo de regressão, observou-se que nenhuma variável foi significativa para a previsão dos níveis de glucose. Quanto à adesão ao tratamento, a variável que mais contribui para a previsão é a depressão. E, com respeito ao estilo de comunicação, observou-se uma correlação negativa, moderada e significativa entre depressão e assertividade. Não foi encontrada nenhuma relação entre a depressão e a comunicação agressiva nem passiva. Em conclusão, apenas duas das relações apresentadas foram corroboradas na análise de rota. Sugere-se confirmar essas descobertas em pesquisas futuras.

Abstract The aim of the present research was to analyze the influence of depression, passive-assertive-aggressive communication styles and adherence to treatment over the glucose levels of subjects with Type 2 diabetes mellitus. Participants were 278 patients with a minimum of one year of having been diagnosed, selected through a purposive non-probability sampling, with ages ranging from 19 to 77 years old, with no amputations, nor comorbidity with nephropathy or diabetic retinopathy. A non-experimental investigation was developed through a cross-sectional design, establishing relationships between variables in a path analysis through multiple regression analyses. The instruments used were the Cuestionario Tridimensional para la Depresión (CTD, for its Spanish acronym) [Three-Dimensional Questionnaire for Depression]; the Autoinformes de Actitudes y Valores en las Interacciones Sociales (ADCAS, for its Spanish acronym) [Self Reports of Attitudes and Values in Social Interactions], and the Instrumento para Medir el Estilo de Vida en Diabéticos (IMEVID, for its Spanish acronym) [Instrument to Measure Diabetic Lifestyles] used to evaluate adherence to treatment. All of these instruments had been validated for the Venezuelan population. In addition, HbA1c was used to measure glucose level. Significant correlations between variables demonstrated to be low (oscillating between r -0.12 and r -0.33), except for two of them considered to be moderate (depression-assertive communication r -0,47 <p 0,05; and aggressive communication-assertive communication r -0,44 <p 0,05). Likewise, from the path analysis, it could be seen that none of the variables were statistically significant for the prediction of glucose levels. In regards to treatment adherence, the variable that contributed the most to the prediction was depression. Concerning the communication styles, negative, moderate and significant associations were observed between depression and assertiveness. No relationship was found between depression and aggressiveness and passiveness. In conclusion, only two of the established relationships through the path analysis were corroborated. Confirmation of these findings is suggested for future investigations.

Is it them or is it us? Unravelling ethnic disparities in undergraduate clinical performance.

Given our increasingly diverse societies, there is an urgent need for research into the causes of persistent ethnic disparities in undergraduate clinical performance. It is argued that causes for underperformance can be identified from two perspectives, namely that of the students ('them') and that of the academic environment ('us'). Taking the 'us' perspective, Yeates et al. conducted a detailed experimental study aimed at understanding the processes underlying judgment and decision-making in clinical assessments. Contrary to their expectations, their study indicates that, despite the presence of active stereotypes, examiner bias does not explain ethnic minority students' underperformance. Naturally, future studies are required to confirm their findings. It is suggested that these studies should take into account various rater and situational factors (e.g. rater experience, increased cognitive load) that may influence examiners' reliance on stereotypes. However, future work should also focus on other potential impeding factors from both perspectives, including differences in communication styles. Knowing what leads to the ethnic disparities in performance is a prerequisite for designing interventions aimed at ensuring a level playing field for a diverse student population.Please see related article: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0943-0.

Outpatient clinic waiting time, provider communication styles and satisfaction with healthcare in India.

Purpose - The purpose of this paper is to evaluate the impact of extended waiting time on patients' perceptions of provider communication skills and in-clinic satisfaction, in three major cities in India. Design/methodology/approach - In total, 625 patients were interviewed. The multivariate general linear model was used to determine the causality and relationship between the independent and the dependent variable. A moderation analysis was also conducted to assess waiting time role as a potential moderator in doctor-patient communication. Findings - Results show that patients with higher waiting time were less satisfied with health care quality. Male patients and patients of male providers were more affected by extended waiting time than female patients and patients of female providers. The advanced regression analysis, however, suggests weak support for waiting time and its effect on overall satisfaction with clinic quality. Waiting time did not moderate the relationship between satisfaction with dominant communication style, and overall satisfaction at the outpatient clinic. Research limitations/implications - A cross-sectional study does not easily lend itself to explaining causality with certainty. Thus, sophisticated techniques, such as structural equation modelling may also be utilized to assess the influence of extended waiting time on satisfaction with healthcare at outpatient clinics. Practical implications - Findings are relevant for providers as the onus is on them to ensure patient satisfaction. They should initiate a workable waiting time assessment model at the operational level. Originality/value - There has been a relatively lesser focus on patient waiting time in patient-provider satisfaction studies. In India, this aspect is still vastly unexplored especially in the context of outpatient clinics. Gender wise pattern of patient satisfaction and waiting time is also missing in most studies.

Communication Styles of Interactive Tools for Self-Improvement.

BACKGROUND: Interactive products for self-improvement (e.g., online trainings to reduce stress, fitness gadgets) have become increasingly popular among consumers and healthcare providers. In line with the idea of positive computing, these tools aim to support their users on their way to improved well-being and human flourishing. As an interdisciplinary domain, the design of self-improvement technologies requires psychological, technological, and design expertise. One needs to know how to support people in behavior change, and one needs to find ways to do this through technology design. However, as recent reviews show, the interlocking relationship between these disciplines is still improvable. Many existing technologies for self-improvement neglect psychological theory on behavior change, especially motivational factors are not sufficiently considered. To counteract this, we suggest a focus on the dialog and emerging communication between product and user, considering the self-improvement tool as an interactive coach and advisor. METHODS: The present qualitative interview study (N = 18) explored the user experience of self-improvement technologies. A special focus was on the perceived dialog between tool and user, which we analyzed in terms of models from communication psychology. RESULTS: Our findings show that users are sensible to the way the product "speaks to them" and consider this as essential for their experience and successful change. Analysis revealed different communication styles of self-improvement tools (e.g., helpful-cooperative, rational-distanced, critical-aggressive), each linked to specific emotional consequences. CONCLUSIONS: These findings form one starting point for a more psychologically founded design of self-improvement technology. On a more general level, our approach aims to contribute to a better integration of psychological and technological knowledge, and in consequence, supporting users on their way to enhanced well-being.

Using a team-centered approach to evaluate effectiveness of nurse-physician communications.

OBJECTIVE: To characterize communication strategies of labor and delivery nurses and their physician colleagues during perinatal decisions. DESIGN: A quantitative descriptive design was used. SETTING: A perinatal setting in an urban acute care facility. PARTICIPANTS: Twenty-nine perinatal nurses and 11 attending physicians. METHODS: A model of team communication derived from research on cockpit crew communication served as a framework for this analysis. Data were taken from transcriptions of audio-taped conversations and discourse analysis. RESULTS: Findings indicated that nurses and physicians tended to use status-based communication styles and rarely employed team-centered communication strategies. CONCLUSION: Nurse and physician status-based communication styles may hinder optimal patient outcomes.