Perceived Quality Of Patient-Provider Communication And Its Influencing Factors Among Elderly Benign Prostatic Hyperplasia Patients Undergoing Surgery
Feb 28, 2025
Abstract
Objective:
To investigate the current status and influencing factors of perceived quality of provider-patient communication in elderly benign prostatic hyperplasia (BPH) patients undergoing surgery, so as to provide a reference for developing targeted provider-patient communication intervention strategies.
Methods:
A total of 208 elderly BPH patients undergoing surgery were selected conveniently. They were investigated using the following tools at 1–2 days before surgery:
General information questionnaire
Montreal Cognitive Assessment (MoCA)
Coping and Adaptation Processing Scale-Short Form (CAPS-15)
FRAIL scale
Hospital Anxiety and Depression Scale
At 2–4 weeks after discharge, they received a telephone follow-up using a self-designed patient-provider communication quality scale.
Results:
A total of 48.08% of elderly BPH patients undergoing surgery reported low quality of provider-patient communication. Logistic regression analysis showed that coping adaptation level, cognitive functioning, ASA classification, and place of residence were the main influencing factors of perceived quality of provider-patient communication in this population (all P < 0.05).
Conclusion:
A significant proportion of elderly BPH patients undergoing surgery perceive low quality of provider-patient communication. Medical staff can develop targeted intervention strategies based on elderly patients' cognitive functions, coping adaptation levels, and other factors to improve their perceived quality of patient-provider communication.
Keywords
Older adults
Benign prostatic hyperplasia
Quality of patient-provider communication
Cognitive function
Adaptation model
Frailty
Anxiety
Depression
Herbal Cistanche Supplements For Promoting Prostate Health
High-quality patient-provider communication (PPC) is the core of achieving person-centered care. It can both enhance patient care satisfaction and improve health-related outcomes [1]. However, studies have shown that patients generally perceive the quality of patient-provider communication to be low [2-3]. In clinical communication, 40%–80% of the information provided by medical staff is immediately forgotten by patients, and over 50% of the recalled information is inaccurate [4]. This increases the risk of adverse events and negatively impacts patients' health-related outcomes. Additionally, according to the literature, 30% of medical lawsuits are attributed to low-quality patient-provider communication [5]. Poor communication quality may lead to discrepancies between patients' surgical expectations and actual health outcomes, making it a primary cause of surgical litigation [6]. High-risk factors for poor patient-provider communication include advanced age, low education level, cognitive decline, anxiety, and depression [7].
Benign prostatic hyperplasia (BPH) is a common urinary dysfunction disease in elderly men, with a prevalence rate of up to 80% in those aged 70 and above. Most cases require surgical treatment [8-9]. Elderly individuals often experience age-related changes in cognition, perception, and sensation, such as memory decline and cognitive impairment, making them a high-risk population for poor patient-provider communication. Improving communication could help determine the optimal treatment plan for BPH patients and may lead to higher treatment success rates and care satisfaction [10]. Given the heterogeneity of patients' communication preferences, tailored communication strategies need to be developed for different populations. However, currently, little is known about the factors influencing the quality of patient-provider communication in elderly BPH patients undergoing surgery.
The Roy Adaptation Model (RAM) is a classic conceptual model that views humans as holistic adaptive systems. When faced with internal and external environmental stimuli, individuals adapt to these changes through innate and acquired coping mechanisms [11]. Based on the Roy Adaptation Model, this study selected research variables to comprehensively assess the factors that may influence the quality of patient-provider communication in elderly BPH patients undergoing surgery. The findings aim to provide a reference for developing targeted communication strategies to improve the quality of patient-provider communication.
1 Subjects and Methods
1.1 Subjects
From September 2023 to January 2024, patients admitted to the Department of Urology at our hospital with benign prostatic hyperplasia (BPH) were selected as subjects using a convenience sampling method.
Inclusion criteria:
Age ≥ 60 years
Meeting the diagnostic criteria for BPH [12]
Scheduled for transurethral green laser enucleation of the prostate
Exclusion criteria:
Patients with stroke or dementia
Patients with malignant tumors
The sample size was calculated as 10–20 times the number of potential influencing factors. Based on literature review and group discussions, this study identified 17 potential factors influencing patient-provider communication. Considering a 10% invalid questionnaire rate, the required sample size was calculated as (170–340)/0.9 = 189–378.
A total of 245 patients were enrolled, and 208 patients completed the study. The study was approved by the Ethics Committee of the First Affiliated Hospital of Army Medical University [(A)KY2023119].
1.2 Methods
1.2.1 Survey Tools
1.2.1.1 General Information Questionnaire
A self-designed general information questionnaire was developed based on literature review. It includes demographic and health-related information:
Demographic information: Age, place of residence, monthly personal income, employment status, years of education, and place of residence.
Health-related information: ASA classification, BMI, and responses to single-item questions about subjective memory decline, regular exercise habits, and participation in intellectual activities (e.g., calligraphy, writing, reading, painting, playing musical instruments, photography, chess, card games/mahjong, or other specified mental activities). Habitual participation in mental activities was considered as engagement in intellectual activities.
1.2.1.2 Patient-Provider Communication Quality Questionnaire
The patient-provider communication quality questionnaire was developed based on relevant literature [13]. The initial draft was reviewed and revised through two rounds of expert consultation involving 8 experts (4 surgical nursing experts, 2 geriatric nursing experts, and 2 urology experts, all with over 10 years of experience; 3 with intermediate titles, 2 with associate senior titles, and 3 with senior titles).
A pilot survey was conducted with 25 elderly BPH surgical patients, and the Cronbach's α coefficient of the questionnaire was 0.850.
The final questionnaire included the following six items, addressing the patient's communication experience with medical staff during hospitalization:
I can understand the conversation content, including knowledge about treatment cooperation and recovery.
Medical staff listen to me attentively and show full respect.
Medical staff explain medical terminology, and verbal explanations are provided for written materials.
Medical staff speak slowly and clearly.
When I do not understand the content of the conversation, medical staff encourage me to ask questions.
Medical staff explain as much as possible about disease-related knowledge, including postoperative complications, self-monitoring, and lifestyle/dietary precautions.
Each item was scored using a Likert 5-point scale, ranging from "almost never" to "almost always," with scores from 1 to 5. Higher scores indicate better perceived quality of communication.
The content validity index for individual items was 0.88–1.00, and the overall scale content validity index was 0.98. Using Kehl et al.'s statistical method [14], questionnaire results were dichotomized:
An average item score > 4 was classified as high-quality communication.
An average item score ≤ 4 was classified as low-quality communication.
In this study, the Cronbach's α coefficient of this questionnaire was 0.758.
1.2.1.3 Montreal Cognitive Assessment (MoCA)
The Montreal Cognitive Assessment, developed by Nasreddine et al. [15], was used to evaluate overall cognitive function. The version translated and revised by Wang Wei et al. [16] was adopted in this study. The scale includes eight dimensions:
Visuospatial and executive function
Naming
Memory
Attention
Language
Abstraction
Delayed recall
Orientation
The total score is 30, with higher scores indicating better cognitive function. To account for the influence of education level on cognitive function, the MoCA score was adjusted by adding one point for participants with less than 12 years of education.
A score ≤ 26 was considered positive for mild cognitive impairment screening. The Cronbach's α coefficient of the scale was 0.782 [16], and in this study, it was 0.707.
