Barreras y facilitadores de la Comunicación en la consulta médica: implicaciones para la

formación y la práctica clínica

La Comunicación es efectiva siempre de acuerdo a sus objetivos: en una consulta médica,

depende de la información obtenida de y por el paciente, adherencia al tratamiento y cambio
comportamental, entre otros. Hay diversos grupos de difícil acceso, como migrantes o
personas con patologías altamente estigmatizadas, que presentan retos específicos en
atención primaria y cuyo abordaje responde a la necesidad de interdisciplinariedad en
atención a la salud pública y comunitaria.

Propósito: esclarecer qué barreras existen dentro de la consulta médica y qué factores
contribuyen a mejorar la comunicación paciente-clínico y determinar qué necesidades, en
consecuencia, existen en lo referido a la formación y en la práctica clínica.

Procedimiento: Esta ponencia virtual corresponde a una parte del marco teórico de una tesis
doctoral; se realizó una búsqueda bibliográfica que arrojó 3580 artículos eliminando
duplicados. Las revisiones sistemáticas y metaestudios fueron extraídos, agrupados por temas
y filtrados por relevancia. En total, 48 artículos, 1 tesis y 4 capítulos de libro pasan al marco
teórico. En los temas “decisiones conjuntas” y “comunicación en la consulta”, se clasificaron 9
artículos.

Resultados: Los factores que condicionan la comunicación pueden ser sistémicos (recursos del
sistema sanitario, universalidad de los servicios de salud, autoritarismo médico y no-
adecuación cultural, culturas organizacionales,etc.), o individuales, ie., intrínsecos
(personalidad, habilidades de afrontamiento, condiciones de salud o motivación) o extrínsecos
(determinantes sociales de la salud, clase social, etnicidad, género, etc.). El valor de la
presente investigación es su capacidad para informar la práctica en atención primaria con
poblaciones socialmente vulnerables.

(Chewning et al., 2011; Edwards, Davies, & Edwards, 2009; Frost, Currie, & Cruickshank, 2015;
Hesse & Rauscher, 2018; Joseph-Williams, Elwyn, & Edwards, 2014; Oprea, 2009; Simmons,
Wolever, Bechard, & Snyderman, 2014; Trappes-Lomax, 2016; Yilmaz, Toksoy, Direk, Bezirgan,
& Boylu, 2017)

Facilitators for engagement, communication and decision making

Positive relationships; affectionate (Frost et al., 2015; Hesse & Rauscher, 2018;
behaviours Joseph-Williams et al., 2014; Oprea, 2009;
Trappes-Lomax, 2016)

Participation in shared-decision making, (Chewning et al., 2011; Frost et al., 2015;

agreements and conversation Hesse & Rauscher, 2018; Oprea, 2009;
Trappes-Lomax, 2016)

Continuity of care; mutual investment in the (Frost et al., 2015; Joseph-Williams et al.,
relationship, at long-term 2014; Oprea, 2009; Trappes-Lomax, 2016)

Intrinsic facilitators of patients: (Edwards et al., 2009; Frost et al., 2015;

empowerment, self-caring skills, copying Oprea, 2009; Trappes-Lomax, 2016)
strategies health status, flexibility and
confidence in oneself

Competencies perceived (emotional (Frost et al., 2015; Hesse & Rauscher, 2018;
intelligence related to communication and Joseph-Williams et al., 2014; Oprea, 2009;
care) Simmons et al., 2014)

Sufficient time for consultation (Frost et al., 2015; Joseph-Williams et al.,

2014)

Nurses as mediators (Joseph-Williams et al., 2014; Trappes-

Lomax, 2016)

Patient-centred care (Hesse & Rauscher, 2018; Trappes-Lomax,

2016)

Intercultural competency (Edwards et al., 2009; Yilmaz et al., 2017)

Rapid access to healthcare (acute) (Trappes-Lomax, 2016)

To have a long-term condition (Joseph-Williams et al., 2014)

Patients' competencies and motivation for (Edwards et al., 2009)

information seeking

Professional culture, background and (Edwards et al., 2009)

assumption of the discourse of "patients‘
choice“ and "autonomy", influential
advocates

Short interventions (Simmons et al., 2014)

Barriers for engagement, communication and decision making

Systemic barriers (service fragmentation, (Frost et al., 2015; Joseph-

overspecialisation, issues in internal communication, Williams et al., 2014; Trappes-
lack of continuity, pressures to reduce consultation Lomax, 2016)
time, etc.)

Traditional power imbalance in the medical (Edwards et al., 2009; Hesse &
consultation, authoritarian professionals; dismiss Rauscher, 2018; Joseph-Williams
patients' effort; disempowerment; medical jargon and et al., 2014; Trappes-Lomax,
unclear language 2016)

Patient's social and material-related barriers (Financial (Frost et al., 2015; Joseph-
hardship, limited literacy, isolation, etc.) Williams et al., 2014; Trappes-
Lomax, 2016)
 Poor communication about daily strategies (Joseph-Williams et al., 2014;
Trappes-Lomax, 2016)

Communication reduced to biological issues and (Joseph-Williams et al., 2014;

outcomes Trappes-Lomax, 2016)

Stigmatisation (Edwards et al., 2009; Joseph-

Williams et al., 2014)

Disease (duration, worsening health, prognosis, lack of (Frost et al., 2015; Trappes-
impact of behavioural change, etc.) Lomax, 2016)¡

Patients' competencies (information seeking and (Edwards et al., 2009; Joseph-

selection, etc.) Williams et al., 2014)

Lack of motivation (From both sides) (Edwards et al., 2009; Joseph-

Williams et al., 2014)

Personality (passiveness, self-esteem, fatalism, (Simmons et al., 2014; Trappes-

dependence, etc.) Lomax, 2016)

Cultural barriers; lack of cultural tailored care (Edwards et al., 2009)

Coping abilities and strategies (Trappes-Lomax, 2016)

(Chewning et al., 2011; Edwards et al., 2009; Frost et al., 2015; Hesse & Rauscher, 2018;
Joseph-Williams et al., 2014; Oprea, 2009; Simmons et al., 2014; Trappes-Lomax, 2016; Yilmaz
et al., 2017)

Chewning, B., Bylund, C. L., Shah, B., Arora, N. K., Gueguen, J. A., & Makoul, G. (2011). Patient

preferences for shared decisions: A systematic review. Patient Education and

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Edwards, M., Davies, M., & Edwards, A. (2009). What are the external influences on

information exchange and shared decision-making in healthcare consultations: A

meta-synthesis of the literature. Patient Education and Counseling, 75(1), 37–52.

https://doi.org/10.1016/j.pec.2008.09.025

Frost, J., Currie, M. J., & Cruickshank, M. (2015). An Integrative Review of Enablement in

Primary Health Care, 6, 264–278. https://doi.org/10.1177/2150131915598373

Hesse, C., & Rauscher, E. A. (2018). The Relationships Between Doctor-Patient Affectionate

Communication and Patient Perceptions and Outcomes. Health Communication, 0(0),

1–11. https://doi.org/10.1080/10410236.2018.1439269

Joseph-Williams, N., Elwyn, G., & Edwards, A. (2014). Knowledge is not power for patients: A

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to shared decision making. Patient Education and Counseling, 94(3), 291–309.

https://doi.org/10.1016/j.pec.2013.10.031

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