Use of standardized patients to examine physicians' communication strategies when addressing vaccine refusal: a pilot study.

Vaccine refusal is increasingly reported but few direct observations of the communication between physicians and parents skeptical about vaccines have been made. In a pilot study, a standardized patient posing as an expectant mother (standardized mother, SM) opposed to immunization met with blinded community physicians under the pretext of prenatal interviews. Persuasive communication strategies were scored using a standardized questionnaire. Recorded transcripts were evaluated for compliance with American Academy of Pediatrics recommendations for handling vaccine refusal. Nine encounters were conducted, representing 16% of pediatric and 3% of family practices in the area. Physicians scored high on listening, maintaining eye contact, spending time with the SM, using understandable terms, and avoiding a paternalistic posture. Lower scores were obtained on encouraging questions, checking for understanding, validating the importance of the SM's concerns, and assessing knowledge about vaccines. The median recorded encounter lasted 19 min. SMs represent a novel strategy for studying physician/parent communication about vaccines.

Complementary and alternative medicine use by primary care patients with chronic pain.

OBJECTIVES: To describe the characteristics and attitudes toward complementary and alternative medicine (CAM) use among primary care patients with chronic pain disorders and to determine if CAM use is associated with better pain control. DESIGN: Cross-sectional survey. SUBJECTS: Four hundred sixty-three patients suffering from chronic, nonmalignant pain receiving primary care at 12 U.S. academic medical centers. OUTCOME MEASURE: Self-reported current CAM usage by patients with chronic pain disorders. RESULTS: The survey had an 81% response rate. Fifty-two percent reported current use of CAM for relief of chronic pain. Of the patients that used CAM, 54% agreed that nontraditional remedies helped their pain and 14% indicated that their individual alternative remedy entirely relieved their pain. Vitamin and mineral supplements were the most frequently used CAM modalities. There was no association between reported use of CAM and pain severity, functional status, or perceived self-efficacy. Patients who reported having at least a high school education (odds ratio [OR] 1.1, 95% confidence interval [CI] 1.02-1.19, P = 0.016) and high levels of satisfaction with their health care (OR 1.47, 95% CI 1.13-1.91, P = 0.004) were significantly more likely to report using CAM. CONCLUSIONS: Complementary and alternative therapies were popular among patients with chronic pain disorders surveyed in academic primary care settings. When asked to choose between traditional therapies or CAM, most patients still preferred traditional therapies for pain relief. We found no association between reported CAM usage and pain severity, functional status, or self-efficacy.