Abstract
BackgroundInformation exchange between physician and patient is crucial to achieve patient involvement, shared decision making and treatment adherence. No reliable method exists for measuring how much information physicians provide in a complex, unscripted medical conversation, nor how much of this information patients recall. This study aims to fill this gap by developing a measurement system designed to compare complex orally provided information to patient recall.MethodsThe development of the complex information transfer measurement system required nine methodological steps. Core activities were data collection, definition of information units and the first draft of a codebook, refinement through independent coding and consensus, and reliability testing. Videotapes of physician-patient consultations based on a standardized scenario and post-consultation interviews with patients constituted the data. The codebook was developed from verbatim transcriptions of the videotapes. Inter-rater reliability was calculated using a random selection of 10% of the statements in the transcriptions.ResultsThirtyfour transcriptions of visits and interviews were collected. We developed a set of rules for defining a single unit of information, defined detailed criteria for exclusion and inclusion of relevant units of information, and outlined systematic counting procedures. In the refinement phase, we established a system for comparing the information provided by the physician with what the patient recalled. While linguistic and conceptual issues arose during the process, coders still achieved good inter-rater reliability, with intra-class correlation for patient recall: 0.723, and for doctors: 0.761. A full codebook is available as an appendix.ConclusionsA measurement system specifically aimed at quantifying complex unscripted information exchange may be a useful addition to the tools for evaluating the results of health communication training and randomized controlled trials.
Highlights
Information exchange between physician and patient is crucial to achieve patient involvement, shared decision making and treatment adherence
The development, refinement and reliability testing of the complex information transfer measurement system involved nine methodological steps: from defining the data needed for building this tool, to collecting it in form of video-recording standardized patient consultations as well as post-consultation interviews, and to shaping the measurement system based on extensive analysis of the former
The complete measurement system is shown in Additional file 1
Summary
Information exchange between physician and patient is crucial to achieve patient involvement, shared decision making and treatment adherence. This study aims to fill this gap by developing a measurement system designed to compare complex orally provided information to patient recall. A key element of health care is for physicians to convey information about treatment choices in a way that patients can understand and later recall it. The importance of such information transfer can hardly be exaggerated, as it represents the condition sine qua non for success of care delivery [1]. Physicians today need to convey multiple, individualized information about uncertainty concerning prognosis, treatment effect, and risk of serious side effects, and at the same time take into account the need for more patient involvement in decision making, which leads to very. Patient recall has been shown to be less than 50% [10, 13]
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