Patient requests in a walk-in clinic. Replication of factor analysis in an independent sample.

Abstract

This study attempts to test the hypothesis that 14 categories of patient requests are relatively independent mathematically. The request categories were identified in the conduct of initial interviews in a walk-in clinic. To test the independence of the 14 request categories, we administered an 84-item Patient Request Form (PRF) to 296 patients coming to the walk-in clinic of a general hospital. In a previous study using a 75-item version of the PRF on a sample of 201 patients, only nine of the request categories were confirmed according to the criterion that three of the five items in the request category appear on the same factor with a loading of 0.4 or greater. The 84-item PRF is a revised form which contains 40 new items designed to capture more accurately the clinical meaning of the requests. Thirteen of the 14 request categories were confirmed in the present factor study using the same confirmation criterion as the earlier study. Three higher order request dimensions were identified by a factor analysis of each patient's 14 request category scores. The request dimensions were for affective-dependence, cognitive understanding, and active intervention. Preferences among the requests are described. The results of this study are relevant in the following ways; 1) knowledge of the range and definition of patient requests enhances the clinician's ability to hear and respond to the patient's request; 2) facilitating the patient's expression of his request enhances the flow of the interview; 3) describing the distinct requests gives clinicians the opportunity to explore the efficacy of various treatment responses to each request; 4) knowing the request facilitates the negotiation process when clinician and patient are in conflict; 5) the PRF serves both as a clinical and a research tool; and 6) the methods used in this study are applicable to other settings, particularly in medical clinics.