Validation of videos

Table 1

Table 2

Table 3
 
 

Validation of videos

It was clearly important to establish that the major difference perceived between the shared and directed versions of each clip was in fact directiveness and not some other attribute such as kindness or doctor competence. After the videos were completed they were viewed by a variety of small groups (comprising four to eight members, some medical and nursing colleagues, general practitioner registrars, and non-medical colleagues). Validators were asked to complete a detailed questionnaire about each video, outlining what they thought were the differences between them. A large number of variables about the doctor, the patient, the consultation, and the problem were measured. (These variables were chosen after discussion with several colleagues with experience in research in the area of doctor-patient communication.) This was to determine whether the difference between the two versions of each scenario was to do with directiveness, and that no other differences were important.

Validators were asked to give a score of between 1 and 4 to a variety of adjectives describing the doctor, the patient, the scenario, and the consultation itself for firstly the directed then the shared version of each scenario. Infrequently, an adjective was not scored, for whatever reason, by the validator. When this happened the adjective was given the midpoint score of 2.5, so it would have no overall effect on the analysis. (The average overall score was 2.58.) The scores given by the validators were added for each adjective, and a comparison was made between the shared and directed scores. They were also asked which scenario, directed or shared, they preferred overall.

Ideally the validation should have been carried out by more people, and more non-medical people, so that proper statistical analysis could be carried out. To view the video and complete each form, however, took about 25-30 minutes of fairly intense concentration. The level of application required to complete this validation was quite high, and so I did not think it appropriate or fair to ask patients to complete it.

Results of validation

The table shows the difference in scores between shared and directed versions of scenarios for the variables describing the doctor and the consultation. In this table scores are shown as a percentage of the maximum possible difference between the shared and directed versions. A minus sign shows that the directed version has a higher score and a plus sign that the shared version has a higher score. There were no major differences between the variables describing the actors.

In all videos there was a big difference between the shared and directed versions in the scoring of the adjectives; directing, authoritative, powerful, and one sided, associated with directiveness, and sharing, cooperative, and negotiated associated with the shared approach. In some there were also big differences in hurried associated with directiveness, and leisurely, good listener, kind, good communicator, patient, and understanding associated with the shared approach. There were no big differences between adjectives describing the patients in any of the scenarios.

There were smaller but consistent differences between the shared and directed versions, over all the scenarios, in the adjectives condescending and confident, which were associated with the directed versions, and worried, friendly, cautious, and approachable, which were associated with the shared versions.

I accepted that directed consultations required less time than shared ones, perhaps leaving the impression with a validator of a doctor with less time to spend and therefore less patience. There was less interaction between the doctor and patient in the directed consultations and so less opportunity to show listening or communication skills. Validators were asked to state what they thought was the main difference between the two versions of each scenario. All validators picked words such as directing, controlling, and authoritative as the main difference.

Difference in scores given by validators between shared and directed versions of scenarios. Numbers in columns represent percentage of maximum possible difference (see text). All differences greater than 50% are typed in bold. The top six differences for each scenario are italicised
 

Table 1

     
    Difference in scores between shared and directed versions of each scenario 
     
    a
    b
    c
    d
    e
    f
    g
    h
    i
    j
    No of validators
    5
    6
    5
    5
    8
    5
    8
    7
    7
    7
    Kind
    +7
    0
    +60
    +7
    +21
    +40
    +50
    +24
    +10
    +21
    Intelligent
    7
    6
    10
    +7
    +4
    +7
    +4
    10
    +7
    5
    Knowledgeable
    7
    11
    7
    +7
    +4
    13
    4
    19
    +19
    14
    Powerful
    53
    89
    63
    67
    50
    53
    54
    67
    33
    52
    Directing
    60
    83
    60
    73
    58
    60
    67
    81
    50
    57
    Authoritative
    60
    83
    47
    73
    63
    67
    67
    71
    60
    81
    Approachable
    +20
    +11
    +47
    +27
    +46
    +27
    +58
    +19
    +48
    +33
    Sharing
    +40
    +44
    +73
    +67
    +63
    +40
    +67
    +48
    +43
    +43
    Cooperative
    +27
    +11
    +53
    0
    +33
    +47
    +63
    +36
    +43
    +29
    Skilled
    13
    22
    +13
    0
    +13
    3
    +29
    21
    +19
    0
    Reassuring
    13
    +33
    47
    +7
    +17
    13
    8
    19
    +33
    10
    Competent
    7
    17
    +6
    0
    +4
    0
    +8
    12
    +19
    7
    Good communicator
    7
    11
    +27
    +13
    +38
    +13
    +50
    2
    +10
    0
    Good listener
    +7
    0
    +53
    +40
    +75
    +40
    +58
    +17
    +48
    +19
    Experienced
    7
    22
    0
    3
    +4
    0
    +4
    +2
    +5
    10
    Patient
    +27
    +11
    +63
    +27
    +50
    +33
    +54
    +36
    +52
    +14
    Understanding
    +7
    0
    +53
    +27
    +38
    +20
    +54
    +31
    +43
    +14
    Cautious
    +27
    +11
    +47
    +13
    +8
    +7
    +29
    +43
    +2
    +19
    Helpful
    0
    17
    +53
    +20
    +13
    +33
    +33
    +17
    +33
    +10
    Friendly
    +13
    0
    +33
    +13
    +33
    +40
    +46
    +31
    +26
    +14
    Fatherly or motherly
    +33
    6
    +27
    13
    +0
    +13
    13
    +14
    +14
    +5
    Confident
    20
    28
    20
    3
    13
    +13
    38
    24
    14
    26
    Worried
    0
    +11
    +10
    +20
    13
    +7
    +19
    +31
    +10
    +24
    Condescending
    10
    +6
    23
    20
    29
    20
    44
    10
    19
    26
    Like my doctor
    27
    44
    +13
    33
    +25
    +17
    +17
    19
    +26
    +5
    Long consultation
    +7
    +22
    +43
    +7
    +13
    +13
    +4
    +24
    +10
    +19
    Short consultation
    7
    17
    13
    7
    21
    40
    17
    19
    14
    19
    Hurried
    13
    22
    33
    7
    50
    40
    46
    24
    50
    29
    Leisurely
    +7
    +22
    +60
    +7
    +42
    +40
    +46
    +38
    +19
    +38
    Negotiated
    +47
    +44
    +87
    +73
    +67
    +53
    +75
    +52
    +62
    +48
    One sided
    33
    39
    67
    73
    83
    60
    92
    14
    12
    48
    Realistic
    13
    28
    +7
    13
    0
    +13
    +21
    27
    19
    29

a=Injury to female; b=injury to male; c=female smoker; d=male smoker; e=mole in female; f=mole in male; g=arthritis in female; h=arthritis in male; I=depression in female; j=depression in male.
 

Table2  How would you rate the doctor in the following categories? Please ring the number closest to what you think

    Characteristic
    Clip A
    		 
    Clip B
     
    Not at all
    		  
    Very
    		 
    Not at all
    		  
    Very
    Kind
    1
    2
    3
    4
    		 
    1
    2
    3
    4
    Intelligent
    1
    2
    3
    4
    		 
    1
    2
    3
    4
    Knowledgeable
    1
    2
    3
    4
    		 
    1
    2
    3
    4
    Powerful
    1
    2
    3
    4
    		 
    1
    2
    3
    4
    Directing
    1
    2
    3
    4
    		 
    1
    2
    3
    4
    Authoritative
    1
    2
    3
    4
    		 
    1
    2
    3
    4
    Approachable
    1
    2
    3
    4
    		 
    1
    2
    3
    4
    Sharing
    1
    2
    3
    4
    		 
    1
    2
    3
    4
    Cooperative
    1
    2
    3
    4
    		 
    1
    2
    3
    4
    Skilled
    1
    2
    3
    4
    		 
    1
    2
    3
    4
    Reassuring
    1
    2
    3
    4
    		 
    1
    2
    3
    4
    Competent
    1
    2
    3
    4
    		 
    1
    2
    3
    4
    Good communicator
    1
    2
    3
    4
    		 
    1
    2
    3
    4
    Good listener
    1
    2
    3
    4
    		 
    1
    2
    3
    4
    Experienced
    1
    2
    3
    4
    		 
    1
    2
    3
    4
    Patient
    1
    2
    3
    4
    		 
    1
    2
    3
    4
    Understanding
    1
    2
    3
    4
    		 
    1
    2
    3
    4
    Cautious
    1
    2
    3
    4
    		 
    1
    2
    3
    4
    Helpful
    1
    2
    3
    4
    		 
    1
    2
    3
    4
    Friendly
    1
    2
    3
    4
    		 
    1
    2
    3
    4
    Fatherly or motherly
    1
    2
    3
    4
    		 
    1
    2
    3
    4
    Confident
    1
    2
    3
    4
    		 
    1
    2
    3
    4
    Worried
    1
    2
    3
    4
    		 
    1
    2
    3
    4
    Condescending
    1
    2
    3
    4
    		 
    1
    2
    3
    4
    The actors 
    Like my doctor
    1
    2
    3
    4
    1
    2
    3
    4
    Young
    1
    2
    3
    4
    1
    2
    3
    4
    Old
    1
    2
    3
    4
    1
    2
    3
    4
    Middle class
    1
    2
    3
    4
    1
    2
    3
    4
    Working class
    1
    2
    3
    4
    1
    2
    3
    4

 

Table 3

    How would you categorise the problem presented? Tick any box which you agree with.
    Characteristic
    Serious 
    Long term 
    Acute 
    Minor 
    Frightening 
    Lifestyle 
     
    Was the consultation ....
     
    Clip A
    		  
    Clip B
    Characteristic
    Not at all
    		    
    Very
    		 
    Not at all
    		  
    Very
    Long
    1
    		 
    2
    3
    4
    		 
    1
    2
    3
    4
    Short
    1
    		 
    2
    3
    4
    		 
    1
    2
    3
    4
    Hurried
    1
    		 
    2
    3
    4
    		 
    1
    2
    3
    4
    Leisurely
    1
    		 
    2
    3
    4
    		 
    1
    2
    3
    4
    Negotiated
    1
    		 
    2
    3
    4
    		 
    1
    2
    3
    4
    One sided
    1
    		 
    2
    3
    4
    		 
    1
    2
    3
    4
    Realistic
    1
    		 
    2
    3
    4
    		 
    1
    2
    3
    4
     
    How would you categorise the patient?
     
     
    Clip A
    		  
    Clip B
    Characteristic
    Not at all
    		   
    Very
    		 
    Not at all
    		  
    Very
    Intelligent
    1
    		 
    2
    3
    4
    		 
    1
    2
    3
    4
    Understands problem
    1
    		 
    2
    3
    4
    		 
    1
    2
    3
    4
    Depressed
    1
    		 
    2
    3
    4
    		 
    1
    2
    3
    4
    Confused
    1
    		 
    2
    3
    4
    		 
    1
    2
    3
    4
    Aggressive
    1
    		 
    2
    3
    4
    		 
    1
    2
    3
    4
    Polite
    1
    		 
    2
    3
    4
    		 
    1
    2
    3
    4
    Irritated
    1
    		 
    2
    3
    4
    		 
    1
    2
    3
    4
    Worried
    1
    		 
    2
    3
    4
    		 
    1
    2
    3
    4
    Nervous
    1
    2
    3
    4
    		 
    1
    2
    3
    4
    Angry
    1
    		 
    2
    3
    4
    		 
    1
    2
    3
    4
    Confident
    1
    		 
    2
    3
    4
    		 
    1
    2
    3
    4
    Controlling
    1
    		 
    2
    3
    4
    		 
    1
    2
    3
    4
    Directive
    1
    		 
    2
    3
    4
    		 
    1
    2
    3
    4
    Good communicator
    1
    		 
    2
    3
    4
    		 
    1
    2
    3
    4
    Young
    1
    		 
    2
    3
    4
    		 
    1
    2
    3
    4
    Middle class
    1
    		 
    2
    3
    4
    		 
    1
    2
    3
    4
    Old
    1
    		 
    2
    3
    4
    		 
    1
    2
    3
    4
    Good looking
    1
    		 
    2
    3
    4
    		 
    1
    2
    3
    4
    Working class
    1
    		 
    2
    3
    4
    		 
    1
    2
    3
    4
    Like me
    1
    		 
    2
    3
    4
    		 
    1
    2
    3
    4
     
    What did you think the main difference was between the two videos?