Active listening in medical consultations: Development of the Active Listening Observation Scale (ALOS-global)

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Abstract

Objective

Active listening is a prerequisite for a successful healthcare encounter, bearing potential therapeutic value especially in clinical situations that require no specific medical intervention. Although generally acknowledged as such, active listening has not been studied in depth. This paper describes the development of the Active Listening Observation Scale (ALOS-global), an observation instrument measuring active listening and its validation in a sample of general practice consultations for minor ailments.

Methods

Five hundred and twenty-four videotaped general practice consultations involving minor ailments were observed with the ALOS-global. Hypotheses were tested to determine validity, incorporating patients’ perception of GPs’ affective performance, GPs’ verbal attention, patients’ self-reported anxiety level and gender differences.

Results

The final 7-item ALOS-global had acceptable inter- and intra-observer agreement. Factor analysis revealed one homogeneous dimension. The scalescore was positively related to verbal attention measured by RIAS, to patients’ perception of GPs’ performance and to their pre-visit anxiety level. Female GPs received higher active listening scores.

Conclusion

The results of this study are promising concerning the psychometric properties of the ALOS-global. More research is needed to confirm these preliminary findings.

Practice implications

After establishing how active listening differentiates between health professionals, the ALOS-global may become a valuable tool in feedback and training aimed at increasing listening skills.

Introduction

Consultations for minor ailments constitute a large part of the workload of general practitioners (GPs) [1], [2]. Most minor ailments generally lack the need for professional medical input and are self-limiting. The reason why patients nevertheless consult their physician is likely to be associated with psychological factors, such as their fear of suffering from a serious condition [3]. In helping patients with minor ailments, GPs affective communication skills, such as active listening, may, therefore, in itself be therapeutic and ameliorative [4]. In addition, active listening may prevent unnecessary repeat visits, therefore, lowering GPs’ workload [5], [6].

Within western medical science, paying attention to the patient from a medical diagnostic point of view (i.e. physical examination) has since long been advocated at the expense of active listening necessary to learn more about the patient's suffering [7]. Yet, patients themselves seem to value the personal, active and listening doctor most [8]. Active listening can be understood as the necessary and first step towards patient centred healthcare that aims to unravel the reasons for visiting the physician from the perspective of the patient. Especially in the absence of serious physical symptoms, listening helps to understand patient's experience of illness [9] through recognizing and exploring patients’ cues. Previous studies indeed show that active listening is associated with satisfaction [10] and with patient disclosure of specific concerns related to the complaints being presented [11].

Active listening is a patient-centred interview skill [12] that encompasses different elements, bearing instrumental and affective significance. On the one hand, active listening is an important instrument for gaining information, e.g. by the use of open ended questions, summaries and clarification [13]. On the other hand, it signifies the acknowledgement of a patient's suffering. What is more, the very act of listening assumes that there is something to listen to, i.e. that the patient has the opportunity to talk and express himself. Active listening, therefore, incorporates verbal as well as non-verbal facilitation of patient talk [14].

Even though the value of active listening has been generally acknowledged, it has almost been taken for granted considering the fact that it has not been studied in depth. So far, the concept has been primarily looked at in a qualitative or global way or using instruments that have either been contextualized in a non-medical setting or capture verbal behaviour only [15]. This article describes the development and initial validation of an observation instrument, called the global Active Listening Observation Scale (ALOS-global), in the context of consultations for minor ailments in general practice.

Section snippets

Subjects

The present study was set within the Second Dutch National Survey of General Practice (DNSGP2), carried out in 2001 by NIVEL, the Netherlands Institute for Health Services Research [16]. During the video-observation part of DNSGP2, 142 GPs were observed by camera during consultations after receiving informed consent by the patient in question [17]. A fixed, unmanned video camera was set up in the consulting room directed at the GP on the front and at the patient from behind or the side. The

Sample characteristics

The sample consisted of 139 GPs, of whom 105 were male (75.5%). Male GPs were on average 47.9 years old (±5.7), female GPs were younger (44.1 ± 7.0 years) (p < 0.01). More than half of the GPs worked fulltime (51.1%). Most GPs (38.8%) worked in a group practice, while 31.7 and 29.5% of the GPs worked solo or with one partner, respectively. GPs were settled for at least 1 year and at most 32 years (average 15.6 ± 8.3 years).

Two hundred and ninety-nine patients whose consultations were recorded (57.1%)

Discussion

This article described the development of a new observation instrument aimed at measuring active listening in general practice, called ALOS-global, the global active listening by observation scale, and its initial validation in the context of consultations for minor ailments. Although the ALOS-global has been constructed for application in observation research, the individual items of the instrument may also provide useful starting-points for individual feedback and education in general

Acknowledgments

We would like to thank Liesbeth van der Jagt from the Dutch College of General Practitioners for her contribution to the development of the instrument. This study was supported by Grant number 42000015 from ZonMw, the Netherlands Organisation for Health Research and Development.

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