Does the quality of patient-physician communication affect health care seeking behavior among the old?: Japan Gerontological Evaluation Study

Background: Poor patient-physician communication is recognized as one contributing factor to health disparities through mechanisms such as poor understanding or adherence to treatment recommendation. Studies indicate that low health literacy often seen in people with low socio-economic status is related to poor communication with doctors. However, in our previous study, lower socio-economic status was not necessarily associated with poor communication with doctors. On the contrary, those with higher socio-economic status tended to report poor communication and less trust in doctors. This study aims at exploring the association between patient-physician communication and health care seeking behavior among the old (65+). Data: We used the A version of the Japan Gerontological Evaluation Study (JAGES) data (N=27,414) conducted in 2013 in 30 municipalities. Patient-physician communication was assessed with three questions; ″How would you rate how well your doctor listened to you?″, ″How would you rate how well the doctor explained things in a way you could understand?″ and “Could you ask doctors questions to clarify your understanding?” We asked about preferred communication style (e.g. paternalistic, partnership, patient-centered) as well. Results: Poor patient-physician communication was strongly associated with delayed care. Especially, those who could not ask doctors questions were more likely to stop seeking care they needed during the past one year irrespective of their socio-economic status. Discussion and conclusion: Among older Japanese, the strongest predictor of “not seeking care when needed” was the lack of adequate communication with doctors. This implies that building a trusting patient-physician relationship contributes to a better treatment outcome.