Patient-physician communication in intercultural settings: An integrative review

Background: Intercultural communication between physicians and patients is a prominent challenge faced by health sectors. This integrative review aims to explore and summarize the current literature examining the cultural factors impacting the communication experience of patients and physicians in healthcare settings and provide an evidence-based solution.

Methods: We used Whittemore and Knafl's (2005) approach to conduct this integrated review of the literature. Primary research studies meeting the search criteria were accessed from Medline/PubMed, Embassy, CINAHL, PsycInfo, ProQuest, Scopus, Web of Science, and Cochrane Review. We included studies published in English from 2008 to 2022. A total of 1731 studies were identified, of which 34 articles were included in this review.

Results: The findings revealed a difference in physicians' communicative behaviour when encountering patients from different cultural backgrounds compared to encounters with patients from the same cultural background. When communicating with patients from different cultural backgrounds, physicians were found to be authoritarian, biomedical-focused, and not involve patients in decision-making. Patients' behaviours during consultations and experience and perception of quality of care in intercultural consultations were varied and inconclusive. Often patients were found to exaggerate respect for physicians, feel uncomfortable with the direct communication style of physicians, have a less proactive attitude, demonstrate low health literacy, and feel shy. These behaviours were attributed to language differences, differences in perception of disease, perception of health communication, prejudice, assumptions, training experience of physicians, and time allocated for consultations. Further, ineffective communication in intercultural consultations was found to impact patient satisfaction, medical adherence, continuity of care, physician's job satisfaction, and ability to diagnose correctly.

Conclusions: Effective communication plays a significant role in patient and physician satisfaction. Health policymakers must formulate appropriate policies that encourage expatriate physicians to develop intercultural competencies to enhance intercultural communication, improve satisfaction, quality decision-making, correct diagnosis, and enhance public health.