Shared understanding in psychiatrist-patient communication: association with treatment adherence in schizophrenia

Rosemarie McCabe, Patrick G T Healey, Stefan Priebe, Mary Lavelle, David Dodwell, Richard Laugharne, Amelia Snell, Stephen Bremner

Research output: Contribution to journalArticlepeer-review

50 Citations (Scopus)


OBJECTIVE: Effective doctor-patient communication, including a shared understanding, is associated with treatment adherence across medicine. However, communication is affected by a diagnosis of schizophrenia and reaching a shared understanding can be challenging. During conversation, people detect and deal with possible misunderstanding using a conversational process called repair. This study tested the hypothesis that more frequent repair in psychiatrist-patient communication is associated with better treatment adherence in schizophrenia.

METHODS: Routine psychiatric consultations involving patients with (DSM-IV) schizophrenia or schizoaffective disorder were audio-visually recorded. Consultations were coded for repair and patients' symptoms and insight assessed. Adherence was assessed six months later. A principal components analysis reduced the repair data for further analysis. Random effects models examined the association between repair and adherence, adjusting for symptoms, consultation length and the amount patients spoke.

RESULTS: 138 consultations were recorded, 118 were followed up. Patients requesting clarification of the psychiatrist's talk and the clarification provided by the psychiatrist was associated with adherence six months later (OR 5.82, 95% CI 1.31-25.82, p=0.02).

CONCLUSION: The quality of doctor-patient communication also appears to influence adherence in schizophrenia.

PRACTICE IMPLICATIONS: Future research should investigate how patient clarification can be encouraged among patients and facilitated by psychiatrists' communication.

Original languageEnglish
Pages (from-to)73-79
Number of pages7
JournalPatient Education and Counseling
Issue number1
Early online date12 Jul 2013
Publication statusPublished - Oct 2013
Externally publishedYes

Bibliographical note

Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.


  • Adult
  • Antipsychotic Agents/therapeutic use
  • Cluster Analysis
  • Communication
  • Comprehension
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Compliance
  • Physician-Patient Relations
  • Principal Component Analysis
  • Psychotherapy
  • Psychotic Disorders/psychology
  • Regression Analysis
  • Schizophrenia/diagnosis
  • Socioeconomic Factors
  • Time Factors
  • Video Recording


Dive into the research topics of 'Shared understanding in psychiatrist-patient communication: association with treatment adherence in schizophrenia'. Together they form a unique fingerprint.

Cite this