Just 26.6% of patients reported strong adherence to treatment in a multicenter mixed-methods study.

In the study, researchers identified four communication challenges in ophthalmic care—patient understanding gaps, emotional engagement, time constraints, and relational continuity—based on input from both patients and ophthalmologists. They also described difficulties in explaining conditions, managing expectations, and supporting treatment adherence.

Time Constraints and Communication Gaps

More than half of both physicians and patients reported that consultation time was insufficient for meaningful discussion. Patients frequently described feeling rushed, which limited their ability to ask questions or fully process information, while physicians reported that time constraints restricted opportunities to address concerns and build rapport.

Despite most physicians reporting confidence in their communication, just 62.6% of them indicated routinely verifying patient understanding, and fewer than one-third of patients reported receiving very clear explanations of their diagnosis. The study described structured communication strategies, including short, open-ended questions, in the context of time-limited consultations.

Impact on Adherence and Expectations

With just 26.6% of patients showing strong adherence to treatment, the researchers indicated that differences between physician expectations and patient beliefs may be linked to lower adherence and dissatisfaction, even when clinical outcomes are favorable. Patients also described difficulty understanding diagnoses and treatment options, often influenced by misleading information from external sources. Physicians similarly reported challenges in explaining complex conditions and managing expectations, particularly in time-limited consultations. The researchers described challenges in managing patient expectations, including situations in which misalignment between physician expectations and patient beliefs was associated with dissatisfaction despite favorable clinical outcomes.

Structured Communication Framework

To address these challenges, the researchers described a structured approach referred to as "Strategic Communication," which includes the O.D.I. method derived from the Italian phrase Osserva, Domanda, Intervieni—or Observe, Question, Intervene.

• Observe: assessing patient understanding, expectations, and contextual factors such as urgency and family involvement

• Question: useing open-ended questions to clarify patient perspectives and identify misunderstandings

• Intervene: focusing on aligning communication and care plans with both clinical priorities and patient preferences.

The researchers outlined a set of brief, open-ended questions designed to encourage patients to share their views and concerns, with examples spanning a range of ophthalmic clinical situations, including questions about expectations for procedures, concerns about treatment, and understanding of their condition.

Practical Application in Clinical Encounters

The researchers described concluding visits with a summary and asking patients to restate next steps in order to check their understanding and reveal misunderstandings. They also noted that short written materials can help reinforce comprehension.

The framework was further presented as supporting shared decision-making by incorporating both clinical considerations and patient preferences into care planning. The researchers described these questions as short and designed to be applied across different ophthalmic clinical scenarios.

Relevance to Clinical Practice

The analysis drew on survey responses from 139 ophthalmologists and 184 patients, supported by qualitative findings from focus group discussions. Although communication was considered an important aspect of care, many physicians reported not having received formal training, even as they expressed interest in developing these skills.

The researchers presented the framework as a structured method that may support patient understanding, trust, and adherence in ophthalmology. Although the study was conducted in a European setting, these findings may be relevant in clinical environments where consultation time is limited.

The researchers noted that additional studies are needed to assess the effects of the framework on clinical and patient-reported outcomes. The study population primarily reflected a European public-sector context, which may have limited generalizability to other health care systems or private practice settings. The study didn't assess whether use of the framework improved clinical or patient-reported outcomes.

"Strategic Communication may represent a paradigm shift in medical practice, offering a structured approach to improving patient–provider relationships," concluded lead study author Mariantonia Ferrara, of the Eye Unit in the Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health at the University of Brescia in Italy, and colleagues.

Co-study authors Greta Mezzetti, Giorgia Raguzzi, and Luca Brambilla reported affiliations with the Accademia di Comunicazione Strategica, which provided training based on the O.D.I. model, while the remaining study authors reported no financial disclosures.

Source: BMJ Open Ophthalmology