Patient Participation In Consultations Research Articles

Gaps in patients’ understanding of palliative chemotherapy. Can we better communicate that treatment is not curative?

SUMMARYMisunderstanding in cancer patients receiving chemotherapy is common. 50% of cancer chemotherapy is given with palliative intent. Many patients receiving chemotherapy for incurable cancer may not understand that chemotherapy is unlikely to be curative.Cancer patients expect to share treatment decisions with their oncologist. Provision of a question prompt list (QPL) and endorsement by physicians enhances patient participation in consultations and promotes patient questions about prognosis.Audio-recordings of oncologist consultations with newly detected incurable cancer patients document that most patients were informed about the aim of cancer treatment and that their disease was incurable. Oncologists checked patient understanding in only 10% of consultations.This review identifies gaps in patient understanding of palliative chemotherapy and examines incurable cancer patients expectations of treatment.

Enhancing patient participation in oncology consultations: a best evidence synthesis of patient‐targeted interventions

Because of the complexity of cancer consultations, the contribution of patients is often limited. This systematic review examined the characteristics and effectiveness of patient-targeted interventions that aim to enhance cancer patients' participation in the consultation. Relevant studies were selected by a search of databases until mid-2010 (Pubmed, PsycINFO and CINAHL), citations in relevant reviews as well as backward/forward citations. A Best Evidence Synthesis was performed, taking into account the quality of studies. A total of 52 publications were included, describing 46 studies and 30 unique interventions. One-third was delivered through either written or multimedia material, two-thirds face to face. Most originated from English-speaking countries. Half targeted heterogeneous cancer populations, one-third targeted women with breast cancer. Half focussed on initial treatment-planning consultations. Overall, there was evidence for an effect on observed patient participation. There was no evidence for an effect on patient or doctor satisfaction and insufficient evidence for an effect on psychological well-being, physical well-being and consultation duration. The findings turned out to be largely independent of study quality. Effect of the interventions could only be demonstrated for immediate outcomes, that is, behaviour observed in the consultation. Implications for future research are discussed, including attention for gaps in the literature as well as the choice of outcome measures.

Promoting patient participation in consultations: a randomised controlled trial to evaluate the effectiveness of three patient-focused interventions

The aim of this experimental study was to evaluate the effectiveness of three patient-focused interventions designed to increase patient question asking in clinical consultations. Patients were randomly allocated to one of five conditions to receive either one of three interventions or to serve as an attention control group or a control group. The primary outcome measure was question asking by the patient of their physician. Participants in the intervention groups did not ask more questions than participants in the control groups. Immediately after the consultation participants in the intervention groups had higher levels of self-efficacy in asking questions. Three months after the index visit patients in the intervention groups were significantly more likely to be satisfied to some degree than patients in the control group. There was no difference in diabetic control. These results suggest that simple brief patient-focused interventions do not change patient behaviour in medical outpatient consultations.

Encouraging patient participation in general practice consultations: Effect on consultation length and content, patient satisfaction and health

Abstract Following the evidence from earlier research that one-to-one interventions can increase the patient's contribution to the consultation, this paper reports the results from a randomised control trial which assessed the effects of a leaflet designed to enhance patient participation in consultations. A random sample of patients (aged 16 to 74) waiting to see a general practitioner were given either an intervention leaflet, which encouraged the patient to take an active role in the consultation, or a control leaflet which gave dietary advice. The effects of the intervention were assessed by measuring length of consultation, number of questions asked by the patient, patient satisfaction score, doctor's feelings about the consultation, the change in patients' health in the 4 weeks following the consultation (measured by the SF-36 Health Survey) and the number of patient visits to a GP in the following year. The results showed that patients in the intervention group had significantly longer consultation...