Operational Definitions of the Research Measures

I. Items in the Sharing Subscale of the Provider-Patient Orientation Scale (answered on 6-point Likert scale)

1. The doctor is the one who should decide what gets talked about during a visit.

2. It is often best for patients if they do not have a full explanation of their medical condition.

3. Patients should rely on their doctors' knowledge and not try to find out about their conditions on their own.

4. Many patients continue asking questions even though they are not learning anything new.

5. Patients should be treated as if they were partners with the doctor, equal in power and status.

6. When patients disagree with their doctor, this is a sign that the doctor does not have the patient's trust and respect.

7. Most patients want to get in and out of the doctor's office as quickly as possible.

8. The patients must always be aware that the doctor is in charge.

9. When patients look up medical information on their own, this usually confuses more than it helps.

II. Active Patient Communication Behaviors25

1. Asking questions—Utterances in interrogative form intended to seek information and clarification (e.g., “What does that medicine do?,”“Why does it hurt when I lift my arm?”, and “When should I get my next check-up?”).

2. Expressions of concern—Utterances in which the patient expresses worry, anxiety, fear, anger, frustration and other forms of negative affect or emotions (e.g., “I'm worried about cancer given my family history”, “I'm so tired of this hurting all the time!,” and “I hated it when my employer switched health plans.”).

3. Assertive responses—Utterances in which the patient expresses his or her rights, beliefs, interests, and desires as in offering an opinion, making recommendations, disagreeing, or interrupting (e.g., “I would like to see if it gets any worse before I think about surgery”, “Could I have a note for my employer?”, and “Before I go, there's one other thing I want to talk about.”).

III. Physician Partnership Building

Utterances that solicit, encourage, or affirm patients' efforts to express their opinions, ask questions, talk about their feelings, and participate in decision making (e.g., “What do you think about that?,”“Is that something you would like to consider?,” and “Sure, that'll be fine” [in response to a patient's request]).