Interrelation of the communicative model of the attending physician with adherence to therapy of patients undergoing coronary bypass surgery

The purpose of this work was to assess the relationship of the communicative models of attending physicians with the commitment to the prescribed treatment of patients undergoing coronary artery bypass grafting (CABG). The study included 366 patients, men, aged 41 to 77 years (mean age 59.9 ± 6.9) with a stable form of ischemic heart disease. We considered communicative competence of the doctor in the form of 3 models: technical, paternalistic and collegial. The technical communicative model was characterized by low rates of openness, flexibility and interest of the doctor in communicating with the patient. Expressive kindness, interest, initiative encouragement, openness, activity, flexibility and differentiation of the doctor in communicating with the patient were characteristic of the paternalistic communicative model. The collegial model included high rates of openness, flexibility and encouragement of the initiative, but with a weakly expressed interest and activity of the attending physician. According to the present study, it turned out that only in a group of patients with a paternalistic model of communication with the attending physician of the stationary stage of postoperative rehabilitation the number of smokers was significantly reduced. Six months after CABG, the index of body mass index in a group with a collegiate and paternalistic model of communicating with a doctor was significantly lower in comparison with a group with a technical model. Levels of low-density lipoprotein and total cholesterol after CABG were significantly lower in the group with the collegial model in comparison with the group of paternalistic communication model of the relationship between the doctor and the patient. In addition, in a group with a paternalistic model, a larger number of patients took 3-4-component treatment in comparison with the technical and collegial communicative model of relationships. In analyzing the relationship between adherence to treatment and the parameters of communicative models, negative associations between body mass index and such parameters as "benevolence", "initiative promotion", "activity" and "flexibility", between the levels of total cholesterol, low density lipoproteins were found. Thus, the higher the patient assessed the communicative parameters of the physician "benevolence", "initiative promotion", "openness", "activity" and "flexibility", which fits the definition of the paternalistic model, the higher its commitment to follow the recommendations for monitoring cardiovascular, vascular risk factors and taking medications in the postoperative period of CABG. Conversely, patients who evaluated the doctor's parameters are closer to the technical communicative model, i.e. poorly expressed "openness", "flexibility" and "interest" in communication, and were the least committed to the recommended therapy. Group of the collegiate communicative model, i.e. with highly expressed "benevolence" and "flexibility", but with a low "interest" and "activity", took an intermediate role in controlling modifiable cardio-vascular risk factors and taking medications.

Keywords

Authors

References