ReviewPatient participation in the consultation process: A structured review of intervention strategies
Introduction
Patient and public participation in decisions about health and healthcare is a central goal of healthcare systems. Enabling patients to effectively communicate personal values, priorities and expectations for health to healthcare providers, to participate in shared decision-making and to evaluate the relative success of healthcare are important elements of patient participation and patient-centred care [1], [2], [3]. Such participation should lead to a more comprehensive appreciation of the health problem, and management solutions and outcomes that are agreed between patient and healthcare provider [2], [4], greater patient adherence, satisfaction with treatment and improved health status may ensue. However, facilitating patient participation throughout the various stages of the healthcare process has wide ranging implications and requires a major shift in the way in which healthcare is delivered. Moreover, uncertainty may exist with regards to the importance of patient participation and rigorous evidence is lacking relating to the mechanisms by which this may be best achieved.
The clinical consultation provides an important opportunity for patients to participate in the healthcare process and to engage with a range of healthcare providers. Increasing the effectiveness of these interactions is essential to patient-centred care. A wide range of methods has been described to facilitate this process, including the provision of checklists for patients [5] and educational programmes for providers [6]. However, there is varying evidence for the relative success of these interventions and clear guidance on the most appropriate methods for enhancing patient participation, and hence improving the quality of patient-centred care, is lacking. Although several published reviews of the effectiveness of interventions are available these are few and have generally limited their coverage to one specific type of intervention, have specified a priori theoretical frameworks, or limited outcomes to be assessed in interventions reviewed [7], [8], [9], [10], [11]. Due to the pressure on healthcare providers to embrace patient-centred care and the expanding nature of the field, it is timely to provide a more inclusive review of the diversity of methods to enhance patient participation in the clinical consultation.
The aim of the study was to describe and review specific practical mechanisms targeted at patients and/or providers and designed to enhance patient participation in the consultation process, and to examine the impact of these mechanisms on the outcomes of care. As with earlier reviews [10], [11], [12] the current review was confined to well-designed studies.
Section snippets
Methods
The starting point for the review was to identify the wide range of patient- and/or provider-targeted mechanisms that were designed to enhance the patients’ ability to participate in the consultation process with a healthcare provider. The common feature was broadly to focus on mechanisms of patient participation and not particular theoretical concepts, philosophies or rationales underpinning patient participation, partnership or involvement.
Patient participation was operationalised as an
Search results
A total of 7532 titles were returned by the electronic search strategies: 3090 main search and 4442 secondary searches. One thousand two hundred and sixteen abstracts were reviewed, of which 193 articles were potentially relevant and reviewed in full. A total of 105 articles met inclusion criteria and were included in the review. Searching the reference lists of included articles and structured reviews of included intervention strategies identified a further 34 articles; 5 additional articles
Discussion
The facilitation of patient participation in the healthcare process is a key element of patient-centred care. This study provides a timely contribution to the field of patient-centred care by describing a wide ranging review and pragmatic classification of intervention strategies, mostly targeted toward the patient, for increasing patient participation in healthcare particularly in the consultation process. Despite being complicated by the wide range of reviewed intervention strategies and the
Acknowledgements
This work was undertaken by Kirstie Haywood, Susan Marshall and Ray Fitzpatrick, on behalf of the Patient-reported Health Instruments Group, National Centre for Health Outcomes Development, University of Oxford. The manuscript is informed by a report to the UK Department of Health (Patient Involvement and Collaboration in Shared Decision-Making: a structured review to inform chronic disease management. The report is downloadable free of charge: http://phi.uhce.ox.ac.uk). The views expressed in
References (59)
- et al.
Patient participation in the cancer consultation: evaluation of a question prompt sheet
Ann Oncol
(1994) - et al.
Improving patients’ communication with doctors: a systematic review of intervention studies
Patient Educ Couns
(2004) - et al.
Evaluation of communication training programs in nursing care: a review of the literature
Patient Educ Couns
(2000) - et al.
Evaluation of a patient education leaflet designed to improve communication in medical consultations
Patient Educ Couns
(1995) - et al.
Enabling the diagnosis of occult psychiatric illness in the emergency department: a randomized, controlled trial of the computerized, self-administered PRIME-MD diagnositic system
Ann Emerg Med
(2001) - et al.
Provider–patient interaction in diabetes care: effects on patient self-care and outcomes: a systematic review
Patient Educ Couns
(2003) - et al.
Patient-centred medicine: transforming the clinical method
(1995) - et al.
Why doctors and patients disagree
Brit J Rheumatol
(1998) - Hibbard JH. Engaging health care consumers to improve the quality of care. Med Care...
- et al.
Patient self-management of chronic disease in primary care
J Am Med
(2002)
A randomized controlled trial of an intervention designed to improve the care given in general practice to Type II diabetic patients: patient outcomes and professional ability to change behaviour
Fam Pract
Decision aids for people facing health treatment or screening decisions
Cochrane Database Syst Rev
Interventions for providers to promote a patient-centred approach in clinical consultations
Cochrane Database Syst Rev
The effectiveness of the use of patient-based measures of health in routine practice in improving the process and outcomes of patient care: a literature review
J Eval Clin Pract
Effect on health-related outcomes of interventions to alter the interaction between patients and practitioners: a systematic review of trials
Ann Fam Med
Provision of feedback on perceived health status to health care professionals
Med Care
Communication skills training for health care professionals working with cancer patients, their families and/or carers
Cochrane Database Syst Rev
Improving the detection and management of depression in primary care
Qual Saf Health Care
Measuring quality of life in routine oncology practice improves communication and patient well-being: a randomized controlled trial
J Clin Oncol
Controlled trial of a patient-completed history questionnaire: effects on quality of documentation and patient and physician satisfaction
Am J Med Qual
Patients with cancer holding their own records: a randomised controlled trial
Brit J Gen Pract
Patient communication skills training for improved communication competence in the primary care medical consultation
J Appl Commun Res
The effects of collaborative goal-focused occupational therapy on self-care skills: a pilot study
Am J Occup Ther
Training psychiatric patients to discuss medication issues
Behav Modif
Pragmatic randomised trial to evaluate the use of patient held records for the continuing care of patients with cancer
Qual Health Care
The weight loss profile: a biopsychosocial approach to weight loss
Int J Psychiat Med
The effects of an ’explicit’ values clarification exercise in a woman's decision aid regarding postmenopausal hormone therapy
Health Expect
A communication skills programme for increasing patients’ satisfaction with general practice consultations
Brit J Med Psychol
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