Although this gap in knowledge was first noted in a systematic review on communication factors published in 1988 (Hall et al 1988), there has been no advance in the field since then. Although previous studies have reported that patient satisfaction with care was associated with clinical outcomes of health interventions (Alazri and Neal 2003, Hirsh et al 2005), an analysis of the direct impact of specific communication

factors Selleck Alpelisib on important clinical outcomes is still warranted, potentially to enable improvement of communication skills with training. In a systematic review recently conducted by our group (Ferreira et al 2011) to examine the effectiveness of training communication skills on the quality of the interaction between patients and clinicians, we found that the interventions currently used to improve communication Gefitinib cell line skills do not improve clinical outcomes in a variety of health settings. Additionally, randomised controlled trials conducted in the USA (Brown et al 1999) and UK (Edwards et al 2004) to improve the communication skills of physicians in primary care and rehabilitation settings reported no effect on patient satisfaction with care. We argue that training of contemporary

communication skills should consider not only the theory supporting specific strategies but also specific factors that have been shown to correlate with how patients perceive the quality of care. The investigated settings involved clinicians and patients from primary care and rehabilitation settings where patients’ needs are similar to patients who seek physiotherapy. We believe that our findings are the best available evidence to guide physiotherapists. In general, our results suggest that few factors are likely to impact on patient satisfaction with care. Communication factors with substantial associations

(r ranging from 0.61 to 0.80) included time spent reading patient charts. No factor identified in this review showed a almost high association (r > 0.81) with patient ratings of satisfaction with care. Comparison of communication factors associated with satisfaction with care among different cultures was not possible as most included studies (69%) were conducted in the USA. We identified inconsistency in the use of classification systems (eg, Roter Interaction Analysis System, Bales Process Analysis System, Verbal Response Mode, and Stiles Coding System) to code communication factors across studies. Studies appear to use different definitions for similar constructs and categories (eg, courtesy and social niceties such as ‘please have a seat’ and ‘thank you’) (Comstock et al 1982, Greene et al 1994). Moreover, studies counted frequency of factors in different ways or used heterogeneous time slices of consultation to code factors (DiMatteo et al 1980, Duggan and Parrott 2000, Mead et al 2002, Street and Buller 1987).