Perceived Quality Of Patient-Provider Communication And Its Influencing Factors Among Elderly Benign Prostatic Hyperplasia Patients Undergoing Surgery Ⅱ
Feb 28, 2025
2 Results
2.1 Perceived Quality of Doctor-Patient Communication, Cognitive Function, Anxiety, Depression, and Coping Adaptation Levels in Elderly BPH Surgery Patients
Among elderly patients undergoing surgery for benign prostatic hyperplasia (BPH), 108 cases (51.92%) perceived high-quality doctor-patient communication, while 100 cases (48.08%) perceived low-quality communication. In this group, 165 cases (79.33%) had positive cognitive impairment screening results, 75 cases (36.06%) had positive anxiety screening results, and 71 cases (34.13%) had positive depression screening results.
Scores for perceived doctor-patient communication quality, cognitive function, frailty, anxiety, depression, and coping adaptation levels in elderly BPH surgery patients are shown in Table 1.
CISTANCHE HERBAL SUPPLEMENTS FOR PROSTATE HEALTH
Table 1: Scores for perceived doctor-patient communication quality, cognitive function, frailty, anxiety, depression, and coping adaptation levels among elderly BPH surgery patients (n=208).
| Item | Total Score (Median, P25, P75) | Average Item Score (Median, P25, P75) |
|---|---|---|
| Doctor-Patient Communication Quality | 24.00 (22.00, 27.00) | 4.00 (3.67, 4.50) |
| Cognitive Function | 21.00 (18.00, 24.00) | 3.43 (3.00, 3.71) |
| Frailty | 1.00 (0.00, 3.00) | - |
| Anxiety | 5.00 (3.00, 7.00) | 0.71 (0.43, 1.14) |
| Depression | 5.00 (3.00, 7.00) | 0.71 (0.43, 1.14) |
| Coping Adaptation | 42.00 (38.00, 47.00) | 2.87 (2.63, 3.13) |
2.2 Univariate Analysis of Perceived Doctor-Patient Communication Quality in Elderly BPH Surgery Patients
Refer to Table 2 and Table 3.
Table 2: Univariate Analysis of Perceived Doctor-Patient Communication Quality in Elderly BPH Surgery Patients (Count Data) Cases (%)
Here is the English translation of the table:
| Variable | Cases | High-Quality Doctor-Patient Communication (n = 108) | Low-Quality Doctor-Patient Communication (n = 100) | χ² | P |
|---|---|---|---|---|---|
| Personal Income (CNY) | |||||
| ≤3,000 | 31 | 7 (22.58) | 24 (77.42) | 39.601 | <0.001 |
| 3,001–5,000 | 77 | 44 (57.14) | 33 (42.86) | ||
| ≥5,001 | 100 | 57 (57.00) | 43 (43.00) | ||
| Primary Memory Decline | |||||
| Yes | 175 | 91 (52.00) | 84 (48.00) | 0.108 | 0.743 |
| No | 33 | 17 (51.52) | 16 (48.48) | ||
| Existing Chronic Disease | |||||
| Yes | 185 | 95 (51.35) | 90 (48.65) | 0.000 | 1.000 |
| No | 23 | 13 (56.52) | 10 (43.48) | ||
| Self-Perceived Health | |||||
| Completely Self-Reliant | 128 | 80 (62.50) | 48 (37.50) | 19.345 | <0.001 |
| Partially Self-Reliant | 80 | 28 (35.00) | 52 (65.00) | ||
| Education Level | |||||
| Urban | 144 | 88 (61.11) | 56 (38.89) | 20.345 | <0.001 |
| Rural | 64 | 20 (31.25) | 44 (68.75) | ||
| Regular Exercise | |||||
| Yes | 127 | 81 (63.78) | 46 (36.22) | 25.277 | <0.001 |
| No | 81 | 27 (33.33) | 54 (66.67) |
Notes:
χ²: Chi-square statistic.
P: Statistical significance level.
Table 2: Univariate Analysis of Perceived Doctor-Patient Communication Quality in Elderly BPH Surgery Patients (Count Data)
| Variable | Cases | High-Quality Doctor-Patient Communication (n = 108) | Low-Quality Doctor-Patient Communication (n = 100) | χ² | P |
|---|---|---|---|---|---|
| Age (Years) | |||||
| <75 | 174 | 96 (55.17) | 78 (44.83) | 11.964 | 0.001 |
| ≥75 | 34 | 12 (35.29) | 22 (64.71) | ||
| ASA Classification | |||||
| I-II | 187 | 104 (55.61) | 83 (44.39) | 16.943 | <0.001 |
| III-IV | 21 | 4 (19.05) | 17 (80.95) | ||
| Type of Surgery | |||||
| TURP | 163 | 95 (58.28) | 68 (41.72) | 17.445 | <0.001 |
| Open Surgery | 45 | 13 (28.89) | 32 (71.11) |
Table 3: Univariate Analysis of Perceived Doctor-Patient Communication Quality in Elderly BPH Surgery Patients (Continuous Data)
| Variable | Mean ± SD | High-Quality Doctor-Patient Communication (n = 108) | Low-Quality Doctor-Patient Communication (n = 100) | t/Z | P |
|---|---|---|---|---|---|
| Age (Years) | 71.82 ± 5.28 | 70.73 ± 4.91 | 73.03 ± 5.43 | -3.260 | 0.001 |
| BMI (kg/m²) | 24.03 ± 2.99 | 24.34 ± 2.93 | 23.70 ± 3.04 | 1.548 | 0.123 |
| Length of Surgery (Minutes) | 91.92 ± 26.52 | 87.49 ± 24.73 | 96.74 ± 27.72 | -2.491 | 0.013 |
| Length of Hospital Stay (Days) | 7.01 ± 2.19 | 6.69 ± 2.03 | 7.36 ± 2.29 | -2.204 | 0.029 |
Notes:
ASA Classification: American Society of Anesthesiologists Physical Status Classification.
TURP: Transurethral Resection of the Prostate.
t/Z: t-test or Z-test statistic.
P: Statistical significance level.
2.3 Multivariate Analysis of Perceived Doctor-Patient Communication Quality in Elderly BPH Surgery Patients
Perceived doctor-patient communication quality among elderly BPH surgery patients was set as the dependent variable (high-quality communication = 1, low-quality communication = 2). Factors with statistically significant differences in the univariate analysis were used as independent variables for logistic regression analysis (α entry = 0.05, α removal = 0.10).
The adjusted model showed that coping adaptation level (input as raw value), cognitive function (input as raw value), ASA classification (III = 1, II = 2), and place of residence (urban = 1, rural = 2) were influencing factors for elderly BPH surgery patients' perceived doctor-patient communication quality. See Table 4.
Table 4: Logistic Regression Analysis of Factors Influencing Perceived Doctor-Patient Communication Quality in Elderly BPH Surgery Patients (n = 208)
| Variable | β | SE | Wald χ² | P | OR | 95% CI |
|---|---|---|---|---|---|---|
| Constant | 15.847 | 4.467 | 41.277 | <0.001 | - | - |
| Place of Residence | 1.563 | 0.492 | 10.084 | 0.001 | 4.776 | 1.378–8.540 |
| Cognitive Function | -0.591 | 0.201 | 8.657 | 0.003 | 0.554 | 0.377–0.813 |
| ASA Classification | -1.086 | 0.518 | 4.401 | 0.036 | 0.338 | 0.123–0.928 |
| Coping Adaptation | -0.134 | 0.047 | 8.047 | 0.005 | 0.875 | 0.794–0.964 |
Notes:
β: Regression coefficient.
SE: Standard error.
Wald χ²: Wald chi-square statistic.
P: Statistical significance level.
OR: Odds ratio.
95% CI: 95% confidence interval.
3 Discussion
3.1 Low Quality of Perceived Doctor-Patient Communication in Elderly BPH Surgery Patients
The quality of doctor-patient communication is closely related to the health outcomes of elderly patients [23]. However, communication in elderly BPH surgery patients has received little attention. This study found that 48.08% of elderly BPH surgery patients reported low-quality doctor-patient communication. Similar results were observed in international studies, where up to 59.6% of elderly surgical patients reported poor communication quality with medical staff [24].
The possible reasons for this include the fact that the average age of participants in this study was above 70. Advanced age can limit older adults' ability to comprehend and recall information [9]. Cognitive decline, such as reduced working memory, which plays a key role in language expression and communication, also becomes more pronounced with age. This suggests that communicating with elderly patients requires more skill [25-26].
Additionally, 36.06% of elderly patients in this study experienced preoperative anxiety, and anxious patients are more likely to report low-quality doctor-patient communication [27]. This highlights the need for medical staff to prioritize communication with elderly BPH patients by assessing their cognitive function and anxiety levels preoperatively and developing personalized interventions.
Efforts should also be made to optimize communication models. Medical staff should learn communication techniques tailored for elderly patients and incorporate auxiliary tools, such as written materials with visuals and videos related to surgical treatment. Moreover, actively involving patients' families in communication can help improve the quality of doctor-patient communication.
3.2 Factors Influencing Perceived Doctor-Patient Communication Quality in Elderly BPH Surgery Patients
3.2.1 Lower Cognitive Function Associated with Lower Perceived Communication Quality
Studies have confirmed that cognitive impairment negatively impacts doctor-patient communication quality [28]. This study showed that elderly BPH patients with lower cognitive function were at a higher risk of reporting low-quality communication (P < 0.05).
In this study, 79.33% of elderly BPH surgery patients had cognitive impairment. Such patients may find it difficult to understand complex clinical instructions or evaluate the consequences of treatment options, leading to challenges in obtaining medical information [29]. This is a key contributor to communication barriers.
Furthermore, elderly BPH patients are at a higher risk of cognitive impairment due to advanced age and the side effects of commonly used treatments [30-31]. Preoperative and postoperative screening for cognitive impairment and its relationship to communication quality are often overlooked in clinical practice.
It is recommended that surgical medical staff evaluate cognitive function in elderly patients preoperatively and adopt appropriate communication strategies, such as slowing the pace of speech, increasing repetition, providing written materials, and using the teach-back method to improve communication quality.
3.2.2 Higher ASA Classification Associated with Lower Perceived Communication Quality
ASA classification assesses surgical risk based on patients' physical health (e.g., comorbidities, frailty) and is an important indicator of health status. A higher ASA classification indicates poorer health. Health status is one of the factors that influence doctor-patient communication in elderly patients [32]. Studies have shown that patients' current health status should also be considered during risk communication [33].
This study found that elderly BPH patients with higher ASA classification were at greater risk of low-quality communication (P < 0.05). Although ASA classification is determined by physical health and cannot be changed in the short term, it can help medical staff quickly identify high-risk groups for low-quality communication preoperatively. This allows for the early implementation of communication strategies to improve communication quality in these groups.
3.2.3 Rural Residents Report Lower Perceived Communication Quality
Regression analysis showed that elderly BPH patients living in rural areas were more likely to report low-quality doctor-patient communication (P < 0.05). According to the literature, rural elderly patients are more likely to experience cognitive impairment compared to their urban counterparts [34], which may contribute to the lower perceived communication quality.
Rural areas typically have fewer educational resources compared to urban areas, resulting in fewer opportunities for education and limited access to information. Patients may not know how to communicate effectively with medical staff, which can impact communication quality.
When communicating with elderly patients from rural areas, medical staff should use simple and understandable language, avoid medical jargon, and respect patients while actively inquiring about their needs. Encouraging patients to ask questions can also enhance communication.
3.2.4 Higher Coping Adaptation Levels Associated with Higher Perceived Communication Quality
This study found that coping adaptation level was a significant factor influencing perceived doctor-patient communication quality (P < 0.05). Patients with higher coping adaptation levels were more likely to perceive high-quality communication.
The Roy Adaptation Model suggests that various stimuli from the internal and external environment, along with coping adaptation levels, are processed by an individual's adaptive system, leading to either adaptive or ineffective responses. In this study, surgery was the primary stimulus, with health-related and sociodemographic factors acting as contextual and residual stimuli. These factors, combined with coping adaptation levels, influenced the outcome.
High-quality doctor-patient communication was considered an adaptive response, while low-quality communication was regarded as an ineffective response. Thus, patients with higher coping adaptation levels were better able to respond positively to the changes brought about by surgery and were more likely to perceive high-quality communication.
Medical staff can enhance communication quality by providing appropriate coping strategies to help patients and their families adapt to the changes brought about by surgery.
