Patient-centred communication and Outcomes Flashcards
Reasons for doctor communication breakdown
Not enough adequate information, underestimate amount of info patients want, spend most time on providing and not checking understanding
Reasons for patient communication breakdown
Doesn’t understand disease or treatment
Ley (1982) factors affecting recall
Diagnosis vs instructions Anxiety Patient factors (family) Perceived importance of statement Number of statements
Ley’s cognitive hypothesis of compliance (1982)
Understanding and memory = satisfaction= compliance
Ley’s 7 recommendations to improve recall (some):
Instructions and advice, stress importance of it, simplify, framework, repeat info, specific advice
Doctor-patient communication research includes
Observing doctors do it, intervening to get patients more involved and intervention by health professionals to empower patients
Observing how doctors do it (Law and Britten, 1995)
41 GPs, taped consultation.
Female better service from women GPs, men= both
Intervening to get patients involved (Rotter, 1977)
294 patients, Baltimore health centre, African Americans. 100 E= prepare q’s. 100= discuss waiting room. Found: E more direct q’s and more likely to keep appointments
Intervening to get patients involved (Greenfield et al., 1985)
Patients prepared and were 2x more effective in obtaining info, more active role in medical decision making
Intervening to get patients involved (Thompson et al., 1990)
Write 3 Q’s to doctor and asked more q’s, were significantly less anxious than control
Intervention by health professionals to empower patients (Kummonth et al., 1998)
Patient-centred training RCT= patients more satisfied with treatment and greater well being but gained more weight
Patient and doctors hidden fears for consultations (Fischer and Ereaut, 2012)
Existential anxiety, entitlement anxiety and interaction anxiety
Important role for health psychologists (2)
Help to develop feasible, effective interventions
Emphasise importance of patient perspective
Measuring health status: stats limitation
Not specific to group and questions are too broad
Measuring health status: bio markers
Many diseases where bio markers not available e.g MS
Measuring health status : QoL
Overall satisfaction with life, specific domains of life
Health related QoL
Values, health concepts such as functioning affected by disease and treatment
WHO factors of QoL
Physical health, psychological health, levels of independence, social relationships, relationship to environment, spirituality
A generic measure of HRQoL
Medical Outcomes Study Short form (SF-36)
Limitations of SF-36 (generic measure of HRQOL)
May be affected by some more than others, individual differences, limitations may not be comfortable to disclose
Advantages of generic measures e.g (SF-36)
Can compare scores across different diseases and to other samples
Disease specific measures are
Designed for particular group, sensitive to small, clinically important changes, more familiar items
Example of disease specific measure of HRQOL
MS Impact scale-29 (MSIS-29)
Evaluation of disease specific measures
People with MS theoretically more pertinent than generic measures and can see where resources can be targeted Riazi et al (2003)
Individualised measures of HRQOL example
Schedule for the evaluation of individual QOL
What is the schedule for the evaluation of individual QOL?
Semi structured interview to elicit 5 areas of life most important to their QOL (0-100 scale)
schedule for the evaluation of individual QOL evaluation
Takes into a con specific, relevant info but would only benefit small population
Potential applications for HRQOL measures
Drug testing, advances in psychometrics
Patient-centredness (Bryne and Long, 1976)
Preferred style of Doctor patient communication as a means to improve patient outcomes
What does a doctor expect from a patient?
Explain symptoms clearly, explain behaviour, listen, take control of symptoms
Savage-Armstrong (1990) criticism of patient centredness?
359 random patients, direct approach= more satisfied than sharing
