The Roter interaction analysis system (RIAS): utility and flexibility for analysis of medical interactions

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Abstract

The Roter interaction analysis system (RIAS), a method for coding medical dialogue, is widely used in the US and Europe and has been applied to medical exchanges in Asia, Africa, and Latin America. Contributing to its rapid dissemination and adoption is the system’s ability to provide reasonable depth, sensitivity, and breadth while maintaining practicality, functional specificity, flexibility, reliability, and predictive validity to a variety of patient and provider outcomes. The purpose of this essay is two-fold. First, to broadly overview the RIAS and to present key capabilities and coding conventions, and secondly to address the extent to which the RIAS is consistent with, or complementary to, linguistic-based techniques of communication analysis.

Introduction

The physician–patient relationship has been described since the time of the Greeks; however, systematic study of the medical dialogue is a modern phenomenon. Technological advances have made observation and analysis of large numbers of medical visits feasible, and indeed, the number of empirical studies of doctor–patient communication has grown markedly over the past two decades. The Roter interaction analysis system (RIAS) has emerged over this period as the most widely used single system of medical interaction assessment. It has been used in over 75 communication studies conducted in North America and Europe, Asia, Africa, and Latin America. These studies have described communication in adult and pediatric primary care, emergency medicine, obstetrics and gynecology, oncology, end of life and palliative care, surgery, nursing, podiatry, genetic counseling, family planning services, and dentistry. (See the website www/RIAS.org for an annotated bibliography of RIAS studies.)

The purpose of this essay is to broadly overview RIAS characteristics and to discuss its capabilities and key coding conventions (detailed examples and coding instructions that are presented in the RIAS code manual are not repeated here because of space limitations). We also take this opportunity to address a variety of questions raised by Sandvik et al. in this issue regarding RIAS coding conventions and the system’s compatibility with linguistic-based techniques of communication analysis [1].

Section snippets

Characteristics of RIAS

The RIAS is derived loosely from social exchange theories related to interpersonal influence, problem solving, and reciprocity [2], [3], [4], [5], [6]. It provides a tool for viewing the dynamics of resource exchange between patients and providers through the medical dialogue. The social exchange orientation is consistent with health education and empowerment perspectives that view the medical encounter as a “meeting between experts” through which dialogue shapes the therapeutic relationship

RIAS and linguistics-based interaction analysis

Sandvik et al. have authored a thoughtful analysis of the RIAS from the perspective of conversation analysis, a particular form of linguistic interaction analysis [1]. In doing so, the authors have raised several broad methodological and measurement issues and have suggested a number of alternatives to RIAS coding conventions. As discussed below, there are tradeoffs for each suggestion and each is considered in regard to practicality, functional utility, coder burden, and conceptual clarity.

Conclusions

Just because a variable can be measured does not necessarily mean that it can provide meaning; conversely, failing to adequately capture a phenomenon does not mean that it lacks significance. Before we can specify what can or should be measured, we must ask ourselves why particular communication variables merit measurement, and where do the variables fit in a broader conceptual and theoretical framework? A weakness that is evident in research endeavors relative to medical communication is a

Note

Our website RIAS.org welcomes visitors interested in posting RIAS-related studies and abstracts, sharing experience in using and adapting the RIAS, and to view the coding manual. Also available on the website is information regarding our software, training, and bibliographic abstracts of studies that have used the RIAS.

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