The patients’ written word: a simple communication aid

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Abstract

Effective doctor–patient communication is an essential part of good medical practice. Question asking is one way for patients to have greater participation. In this feasibility study, patients were given the opportunity to list questions or discussion topics on a proforma before seeing the doctor in an oncology outpatient clinic. The items listed were reviewed by the clinic doctor. Eighty-eight of 100 patients approached agreed to participate. Biomedical questions (mean 2.0 per patient) predominated over psychosocial ones (mean 0.1 per patient). Possible reasons for this are the study researcher being a doctor, patients attending for test results or that patients consider the format of listing questions on a proforma inappropriate for psychosocial issues. The listing of questions and discussion topics by patients gave the doctor valuable information about the patients’ understanding and use of language. While the importance of doctors being adequately trained in communication skills should not be ignored, this simple intervention has potential for improving the outcome of clinic consultations.

Introduction

Patients have differing information needs and derive material from different sources [1], [2], [3], [4], [5]. Unvoiced agendas may exist when patients consult their doctors [6] and doctors may fail to elicit all of the patients’ reasons for attending [7]. Emotional and social agendas are likely to be underrepresented [6], [8]. Patients have been shown to need to receive information to make treatment choices even if the doctor takes the lead in making the actual decision, known as psychological autonomy [3]. Since effective doctor–patient communication can improve health outcomes such as emotional health, function, symptom resolution and pain control [9], it is important to examine ways in which it might be optimised.

Various communication interventions have been investigated. Communication training for health care professionals has been shown to have a significant effect on their communication skills [10], [11]. Facilitating patients’ participation in the health professional consultation by coaching them to have a more active role has also been investigated [12], [13], although this did not have a significant effect on consultation outcome. Another intervention investigated has been question prompt sheets and problem checklists [12], [14], [15], [16]. They have been used in the cancer setting and consist of a list of suggested questions for patients to tick and additional free space in which to add other questions. It was found that the length of consultations decreased and the number of questions relating to prognosis [14], [15], tests and treatment [12] increased, if the question prompt sheets were reviewed by the doctor. They do, however, have limitations in so much that listing questions for patients to tick is patronising and paternalistic and it might even influence their agendas. In fact, the listing of questions for patients to tick is almost doing the opposite of encouraging them to voice their personal agendas.

The intervention used in our study was a proforma on which there was the statement “Please list below any questions or items that you would like the doctor to discuss when you see him or her in your clinic consultation”, followed by five spaces and additional free space for patients to list questions and discussion topics. Patients completed the proforma before their outpatient clinic consultation at a regional oncology centre and the questions listed were reviewed by the doctor in the consultation. The aim of this study was to investigate the extent to which patients made use of this facility to list questions and discussion topics. The number and content of questions listed was evaluated, content being classified as either biomedical or psychosocial. The implications of using these listings in routine practice are discussed.

Section snippets

Methods

Four consultant oncologists included their patients in the study. A letter and patient information sheet was sent to 100 randomly selected patients approximately 2 weeks before their clinic appointment. The researcher approached each patient on arrival at clinic and asked if they were willing to participate, even if they did not have any questions or topics to list. He explained the study participation sheet to each participant, showing where on it they should list various details about

Results

The number of questions listed (and the number of patients listing that number of questions) was 0 (23), 1 (13), 2 (13), 3 (21), 4 (10), 5 (7) and 7 (1). The average number of questions listed per patient was 2.1 (mean), 2 (median). Biomedical questions (2.0 mean, 2 median per patient) were listed more often than psychosocial (0.1 mean, 0 median per patient). See Table 1 for examples of different types of questions and topics listed.

The number of questions listed was not related to prognosis,

Discussion and conclusion

The results of this feasibility study indicate that a large proportion of patients choose to use the facility of listing questions and topics on a proforma before consultation. Study recruitment was good, being 88%. Of the 88 participants, 65 listed one or more questions/topics. Nonetheless, it is unknown whether these issues would have been raised in any case. Also, patients might have felt obliged to list items simply because the doctor was indirectly asking them to do so, the listing

Acknowledgements

Consultants who allowed access to their patients; Research Development and Support Unit, United Bristol Healthcare Trust, for advice on statistical analyses. The Department of Social Medicine of the University of Bristol is the lead centre of the MRC Health Services Research Collaboration.

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