Open research questions in Patient-Provider Communication in Healthcare

What the literature leaves open

• BackgroundLarge language models (LLMs) are increasingly deployed in healthcare, where they may adopt different stakeholder perspectives, yet the effect of role-prompting on clinical ethical reasoning remains poorly characterized.

  Role-Prompting in Frontier Large Language Models Influences Clinical Reasoning in Complex Medical Cases · 2026 · DOI

• This review was limited to literature published in peer- reviewed academic journals. Inclusion of unpublished reports from HTA agencies may well have provided fur- ther in-depth information on what happens in practice. To explore further nuances, future research could survey HTA agencies and conduct literature review of grey lit- erature to provide further insights as to how and why dif- ferential approaches are used when incorporating experts into research and their relative strengths and weak- nesses. In the survey of methodological experts, whilst 18 respondents began the survey, only 11 respondents completed it, limiting the final sample of responses, and therefore the validation on the proposed categorisation of methods. The methodological and reporting criteria were proposed based on the empirical literature retrieved and refined by authors to confirm that each were concep- tually relevant to at least one method of expert consul- tation. As a preliminary framework they are suggestions to improve planning, conduct and reporting, rather than prescriptive. Although informed by HTA literature, fur- ther work across other decision-making domains is needed to assess generalisability. Future research may apply and further refine the INTEGRITY framework across diverse decision-making contexts to evaluate its usefulness for strengthening transparency and research integrity when incorporating expert judgement.

  Expert opinion in decision-making: a systematic review of methods and the INTEGRITY framework for incorporating expert consultation into research · 2026 · DOI

• Future studies should explore whether simi- lar patterns of agreement and patient partner contribu- tions are observed with larger and more diverse rater groups. f SDM that could be explored through separate qualitative appraisal or addi- tional measures alongside observer-based instruments.

  Involving patient partners as appraisers of shared decision making: an explanatory sequential mixed-methods study · 2026 · DOI

• The findings of this study highlight the need to revisit how communication is taught in optometry programmes. Whilst real-world experience remains an influential teacher, it should be complemented by structured communication training that begins early in the curriculum and continues longitudinally throughout clinical placements. Topics such as empathy, cultural competence, conflict resolution and shared decision-making should be integrated as core competencies assessed with the same rigour as technical skills. Furthermore, incorporating feedback from patients and supervisors during training could help align self- perceived communication abilities with actual performance. Future research should investigate the long-term impact of formal training interventions on practitioner competence and patient care outcomes.

  Confident but undertrained: South African optometrists’ reflections on communication training · 2026 · DOI

• Our study has several key limitations that are worth acknowl- edging. First, our design is a cross-sectional design, limiting any causality conclusions. In addition, the reliance on self- reported measures and convenience sampling may result in recall bias and cause generalizability concerns. Future work should (1) test these relationships longitudinally from diagnosis through early treatment, (2) identify which PCC sub-dimensions most strongly drive preparedness, and (3) evaluate literacy-adapted communication interventions and decision-support tools, especially those designed for low literacy in lung cancer settings. Work testing low-literacy conversation tools in lung cancer decision-making contexts illustrates the feasibility of this direction.

  Predictors of Treatment Preparedness Among Lung Cancer Patients: The Role of Patient–Provider Communication · 2026 · DOI

• Future work can strengthen inference by using discrete choice experiments or conjoint designs to quantify trade-offs between credentials, access, cost, and experience attributes rather than testing each factor in isolation. Multivariable modelling can evaluate independent predictors of high importance ratings while adjusting for confounding and interaction, especially for age and gender effects. Longitudinal designs could link stated preferences to downstream outcomes such as adherence, follow-up completion, switching behavior, and patient-reported experience measures. Older participants in our cohort were more likely to prioritize professional experience, modern diagnostic equipment, community reputation, and short waiting time. This is consistent with risk calibration and burden of disease logic, as older patients have a higher baseline prevalence of chronic eye disease and may anticipate more complex care episodes, making technology, experience, and operational efficiency more valuable [29]. The wait time effect is strongly supported in eye care settings, including quality improvement work and ratings analyses linking shorter waits to higher satisfaction and better public evaluations [30].

  Factors Affecting Patients’ Selection of an Ophthalmologist in Saudi Arabia: A Patient-Centered Cross-Sectional Study · 2026 · DOI

• This study benefits from the inclusion of both patient and provider perspectives, the use of validated instruments (SDM-Q-9, SDM-Q-Doc, HELIA) [13–15], and a rela- tively large sample of patients. However, several limitations should be considered. The cross-sectional design precludes causal inference. Patients and healthcare providers were not paired and may have evaluated different decision-making processes, limiting the ability to draw conclusions about shared experiences within the same clinical encounter. The reliance on self- reported measures may introduce bias. Healthcare pro- viders may overestimate their engagement in SDM due to social desirability or professional expectations, while patients may under- or overestimate their experiences due to recall bias or cognitive factors associated with PD. These biases may have contributed to the observed differ- ences in perceived SDM and should be considered when interpreting the findings. The sample overrepresented White/Caucasian participants, limiting generalizability to more diverse populations.

  Exploring perceptions and predictors of shared decision-making in the pharmacological management of Parkinson’s disease: insights from patients and healthcare providers · 2026 · DOI

• The protocol specifies data collection methods comprehensively but lacks clarity on qualitative data organization, management, and coding frameworks. The specific qualitative coding framework and how coded data will be organized for analytical use are not explicitly detailed in the protocol description.

  Protocol for a mixed methods process evaluation for a randomised controlled trial to improve shared decision-making about, and uptake of, osteoporosis medicines: the iFraP study · 2026 · DOI

• With only 20 participants per arm, the iFraP study cannot conduct subgroup analysis to determine whether the shared decision-making intervention benefits all equity groups (age, ethnicity, socioeconomic status) equally. Differential effectiveness across demographic populations remains unexamined.

  Protocol for a mixed methods process evaluation for a randomised controlled trial to improve shared decision-making about, and uptake of, osteoporosis medicines: the iFraP study · 2026 · DOI

• The iFraP study is limited to four UK Fracture Liaison Services; scalability to busier or less well-resourced services with variable IT infrastructure and staffing remains unexamined. The requirement for longer consultations may not be implementable in services with different organizational capacity or resource constraints.

  Protocol for a mixed methods process evaluation for a randomised controlled trial to improve shared decision-making about, and uptake of, osteoporosis medicines: the iFraP study · 2026 · DOI

• The protocol does not include baseline or follow-up assessment of clinician attitudinal commitment to shared decision-making as a predictor of intervention fidelity. Clinician beliefs about the benefits and efficiency of SDM are not measured despite potential strong influence on delivery consistency and sustainability of the iFraP intervention beyond the trial period.

  Protocol for a mixed methods process evaluation for a randomised controlled trial to improve shared decision-making about, and uptake of, osteoporosis medicines: the iFraP study · 2026 · DOI

• The fidelity assessment in the iFraP study measures whether consultation tasks were completed but lacks teach-back analysis to evaluate whether patients actually understood their fracture risk or treatment rationale. Consultation recordings are available but currently underutilized for assessing patient comprehension and absorption of shared decision-making content.

  Protocol for a mixed methods process evaluation for a randomised controlled trial to improve shared decision-making about, and uptake of, osteoporosis medicines: the iFraP study · 2026 · DOI

• Following open questions about the impact of the pain on daily life, patients may be able to identify times in the past when they have been able to engage in important activity, despite symp- toms. The MI practitioner can reflect the observations made by the patient, highlighting that on occasion, they have been able to participate in an enjoyable activity. The patient is encouraged to think further about the circumstances surrounding the occa- sion(s) and identify positive contributory factors which can be replicated in the future. An MI approach to this situation can assist the patient to define their own motivation to change and potential solution. ANAESTHESIA AND INTENSIVE CARE MEDICINE 26:5 247 (cid:1) 2025 Published by Elsevier Ltd. PAIN The reflection aspect of MI can be particularly powerful when a patient is angry or frustrated. In such circumstances it is easy for the practitioner to become defensive or to try to present an alternative way of viewing the situation, which can antagonize the situation. By verbally reflecting the emotions that the patient is describing, the clinician demonstrates empathy for the distress without confrontation and this is a highly effective mechanism for de-escalation. Scenario 7 e Angry or frustrated patients There are many reasons why patients may attend appointments feeling angry and frustrated. Common scenarios may be feeling disbelieved, concerns about care, delays and enforced changes to medication. Rather than engaging in confrontation or justifying previous actions, the clinician may choose to reflect that the patient is upset, acknowledging the reasons for this. A reflective approach can often diffuse the tension and allows the patient to elaborate further on their concerns. As a result, the patient starts to feel understood and the relationship is improved. A more productive conversation can then ensue, which may involve further exploration of the concerns raised.

  Communication skills in pain medicine · 2025 · DOI

• Using play-based interviews and a questionnaire with child- friendly questions, we involved children and adolescents to inform the development of a communication curriculum for HCPs. Only few previous studies have included this groups’ perspectives in curriculum development [16, 19]. In “twelve tips for patient involvement in healthcare education”, Eijkel- boom et al. [18] state that patients should always participate in curriculum design and development. We only included patients in identifying goals, learning objectives, and com- petencies, and did not involve them in verifying our findings, but this will be done at a later stage. We used two different types of data collection, but the analytical aim to explore children and adolescents’ hospital experiences and percep- tions of healthcare professionals was consistent. Although children aged 5–6 years were included in both data sets, our analysis did not reveal any notable differences between the findings from the two data collection approaches. The questionnaire involved a sample of children, adolescents, and their parents who had voluntarily signed up as members of a user panel in the design of a new children’s hospital. This may limit generalizability due to differences between volunteers and the broader target population, including disadvantaged groups such as migrants. We also allowed parents to assist in completing the questionnaire and quote their child. Therefore, we cannot be completely sure that the responses only reflect the child’s own opinion. Another potential limitation is the lack of consideration for co-occur- ring neurodevelopmental disabilities or neurodivergence among the participants, which may influence communication approaches. Moreover, we did not ask about specific diag- nosis of the questionnaire participants. However, our aim was to investigate children and adolescents’ general percep- tions of healthcare professionals, irrespective of their health status. Most existing patient-reported experience measures in paediatrics also aim to measure general experiences of healthcare regardless of diagnosis [41]. Future research may benefit from distinguishing between the perceptions of healthy subjects and subjects with medical conditions. A potential limitation is that we did a secondary analysis of qualitative data, raising various methodological concerns [42]. In our case, however, the interviews were conducted relatively recently (2021), and the aim of the present study matched that of the original study well.

  Paediatric patient perceptions of healthcare professionals: contributions to a communication curriculum · 2024 · DOI

• INTRODUCTION: The real-world mechanisms underlying prospective entrustment decision making (PEDM) by entrustment or clinical competency committees (E/CCCs) are poorly understood.

  A realist synthesis of prospective entrustment decision making by entrustment or clinical competency committees · 2023 · DOI

• E/CCCs that seek to be deliberate describe PEDM that can be effortful (when data are insufficient or incongruent) or effortless (when data are robust and tell a congruent story about a trainee).

  A realist synthesis of prospective entrustment decision making by entrustment or clinical competency committees · 2023 · DOI

• CONTEXT: Public opinion on the performance of health system actors is polarized today, but it remains unclear which actors enjoy the most or the least trust among Democrats and Republicans, whether the COVID-19 pandemic has influenced how people view their own physicians, and whether doctors have retained the ability to influence public beliefs about policy issues.

  Polarization, the Pandemic, and Public Trust in Health System Actors · 2023 · DOI

• PURPOSE: Breast cancer survivors' (BCSs') sexual health (SH) clinical conversations are rarely studied from a dyadic perspective let alone from a triadic perspective.

  Partner presence in clinical conversations about sexual health: Breast cancer survivors’, partners’, and providers’ perspectives of triadic interactions · 2022 · DOI

• Internationally, there is a great focus on shared decision-making as a way to help patients and healthcare professionals to make informed decisions together; nevertheless, research focusing on patient experiences shows that information about clinical trials is insufficient in supporting patients to make trial decisions in the context of their course of disease and managing life with advanced cancer.

  When life gives you no choice: Context of decision‐making when offered an oncology clinical trial · 2021 · DOI

• Future research should explore if repeated opportunities to use the 15-min simulation as well as providing users with several different conversations to practice with would result in sustained improvements in antibiotics beliefs and knowledge and communication behaviors over time.

  Simulated Conversations With Virtual Humans to Improve Patient-Provider Communication and Reduce Unnecessary Prescriptions for Antibiotics: A Repeated Measure Pilot Study · 2017 · DOI

• Therefore, we recommend further research into and enhancement of existing instruments in terms of validity and reliability, along with enhancement of their generalisability, responsiveness and aspects of interpretability in different contexts (real patients, simulated patients, doctors in different specialties, etc.

  Assessing patient‐centred communication in teaching: a systematic review of instruments · 2017 · DOI

• PURPOSE: Although surrogate decision-making (SDM) is prevalent in intensive care units (ICUs) and concerns with decision quality are well documented, little is known about how clinicians help family members understand the surrogate role.

  How do clinicians prepare family members for the role of surrogate decision-maker? · 2017 · DOI

• RATIONALE: Uncertainty tolerance (UT) is an important, well-studied phenomenon in health care and many other important domains of life, yet its conceptualization and measurement by researchers in various disciplines have varied substantially and its essential nature remains unclear.

  Tolerance of uncertainty: Conceptual analysis, integrative model, and implications for healthcare · 2017 · DOI

• However, person-centred communication is interpreted and applied variably in different settings, and healthcare professionals' views about communicating with PLWD are under-explored.

  Medical students’ views about person-centred communication in dementia care · 2016 · DOI

• In such cases, physicians generally judge that there is insufficient likelihood or magnitude of benefit to justify the burdens or expense of treatment, while patients or surrogates believe that the small chance of preventing the patient's death is sufficient to justify the costs and potential burdens to the patient.

  Surgeons, Intensivists, and Discretion to Refuse Requested Treatments · 2014 · DOI

Most-cited papers in Patient-Provider Communication in Healthcare

• Race, Gender, and Partnership in the Patient-Physician Relationship · JAMA · 1999 · 1,596 citations
• Trust in Physicians and Medical Institutions: What Is It, Can It Be Measured, and Does It Matter? · Milbank Quarterly · 2001 · 1,084 citations
• Physician Gender Effects in Medical Communication · JAMA · 2002 · 1,078 citations
• Efficacy of Communication Skills Training for Giving Bad News and Discussing Transitions to Palliative Care · Archives of Internal Medicine · 2007 · 673 citations
• Physician Gender and Patient-Centered Communication: A Critical Review of Empirical Research · Annual Review of Public Health · 2004 · 478 citations
• Tolerance of uncertainty: Conceptual analysis, integrative model, and implications for healthcare · Social Science & Medicine · 2017 · 430 citations
• Changing physicians' behavior: What works and thoughts on getting more things to work · Journal of Continuing Education in the Health Professions · 2002 · 323 citations
• Using icon arrays to communicate medical risks: Overcoming low numeracy. · Health Psychology · 2009 · 322 citations
• Advance Directives as Acts of Communication · Archives of Internal Medicine · 2001 · 315 citations
• Physician communication skills training: a review of theoretical backgrounds, objectives and skills · Medical Education · 2002 · 236 citations

Most recent work

• Health Communication Ethics From the Perspectives of the Patient and the Health Practitioners in Ghana · Journal of Evaluation in Clinical Practice · 2026
• Patient Digital Engagement With After Visit Summary in Ambulatory Care · JAMA Network Open · 2026
• The first steps in the evaluation of a "black-box" decision support tool: a protocol and feasibility study for the evaluation of Watson for Oncology · Journal of Clinical and Translational Research · 2026
• Patients’ Perceptions of Physicians’ Health Literacy Competencies and “Good” Communication in Family Medicine: A Q Methodology Study · INQUIRY The Journal of Health Care Organization Provision and Financing · 2026
• Protocol for a mixed methods process evaluation for a randomised controlled trial to improve shared decision-making about, and uptake of, osteoporosis medicines: the iFraP study · NIHR Open Research · 2026
• Attitudes Toward Breaking Bad News Among Physicians in Türkiye · STED / Sürekli Tıp Eğitimi Dergisi · 2026
• Navigating trust dynamics in online health communities: the impact of doctors’ attributes and patient feedback · Humanities and Social Sciences Communications · 2026
• Exploring perceptions and predictors of shared decision-making in the pharmacological management of Parkinson’s disease: insights from patients and healthcare providers · Drugs & Therapy Perspectives · 2026
• Providing information to prepare breast cancer patients for their surgical consultation: barriers and recommendations (an analysis from Alliance A231701CD) · Supportive Care in Cancer · 2026
• From conversation to completion: identifying conversation elements to support effective shared decision-making for lung cancer screening in rural primary care · BMC Primary Care · 2026

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