Technical failures in audiorecordings reduced the sample sizes from 56 to 50 patients and from 20 to 19 clinicians. Clinicians included five psychiatrists, five licensed clinical professional counselors, one licensed graduate professional counselor, four licensed graduate social workers, two licensed clinical social workers, a clinical psychologist, a registered nurse with a master’s degree in nursing, and another clinician with unspecified training. All the counselors and social workers had master’s degrees at minimum; differences in titles reflect Maryland state licensure requirements.
The average number of patients enrolled in the study for each clinician was 2.8 (range one to 12). There were no statistically significant differences in the number of patients in the intervention and control groups seen by psychiatrists or other clinicians. Eleven of the visits by patients in the intervention group were with psychiatrists, five were with clinical counselors, five were with clinical social workers, one was with a clinical psychologist, one was with a registered nurse with a master’s degree in nursing, and one was with a clinician with unspecified training. Fifteen of the visits by patients in the control group were with psychiatrists, one was with a clinical counselor, seven were with clinical social workers, two were with clinical psychologists, and one was with a clinician with unspecified training.
Overall, patients were predominantly African American (N=34, 68%), had less than a high school education (N=29, 58%), had an average age of 50, and had never married (N=37, 74%). A total of 16 (32%) were living with family members, 16 (32%) were not living with family but saw them regularly, and 18 (36%) did not see family regularly or had no family in the area. Most patients (N=44, 88%) obtained health insurance coverage through Medicare, Medicaid, or the Department of Veterans Affairs. Fifteen (30%) patients reported receiving Social Security Disability Insurance, and 28 (56%) received Supplemental Security Income. Eight (16%) patients reported some earned income, and six (12%) reported receiving regular contributions from family and other sources. There were no statistically significant differences between intervention and control groups on any of these measures ().
Characteristics of patients who used a Web-based intervention and a control group
As shown in , visits by patients in the intervention and control groups differed in a number of ways. Visits by patients in the intervention group were several minutes longer compared with visits by patients in the control group (23.7 versus 19.3 minutes, respectively; p<.05). Patients in the intervention group contributed more actively to the dialogue compared with patients in the control group (288 versus 229 statements per visit; p<.05). The number of statements by clinicians per visit and the total number of statements per visit were higher among visits by the intervention group compared with visits by the control group, but the differences were not statistically significant. Consistent with these dialogue characteristics, the verbal dominance of the clinician was lower in the intervention compared with control group visits.
Communication during visits by patients who used a Web-based intervention and a control groupa
The patient-centeredness ratio was significantly higher during visits by patients in the intervention group compared with visits by patients in the control group (8.5 versus 3.2; p<.05), as shown in . A higher patient-centeredness ratio indicates that the visit featured a relatively greater emphasis on psychosocial and lifestyle categories in contrast to biomedical exchange.
More specifically, patients in the intervention group asked more questions about their treatment regimen and tended to discuss psychosocial issues more often than control group patients. They also gave more information about their lifestyles to the therapist and were more likely to check their understanding of information communicated to them (). There were no differences between the groups in the number of socioemotional statements, such as expressions of concern, optimism, agreement, or disagreements (data not shown).
Characteristics of communication during visits by patients who used a Web-based intervention and a control group, by number of statements
During visits with patients in the intervention group, clinicians were significantly less likely to ask questions about the treatment regimen or medical symptoms but were more likely to express empathy and to use more facilitators and cues of interest to encourage the patient to continue to speak (). There were no differences between visits by the two groups of patients in other categories of clinician socioemotional or biomedical exchange (data not shown).
Emotional tone of the dialogue differed for both patients and clinicians depending on the study group (). Patients in the intervention group were rated as more dominant and respectful than those in the control group. They were also rated as sounding more distressed, but the trend did not reach statistical significance. During visits with patients in the intervention group, clinicians were rated as sounding more sympathetic and warm than during visits with the control group; they were also rated as sounding more engaged in dialogue with intervention group patients, but the trend was not statistically significant.
Affective tone during visits by patients who used a Web-based intervention and a control groupa