Patient-centred communication and Outcomes

Question 1

Reasons for doctor communication breakdown

Answer 1

Not enough adequate information, underestimate amount of info patients want, spend most time on providing and not checking understanding

Question 2

Reasons for patient communication breakdown

Answer 2

Doesn’t understand disease or treatment

Question 3

Ley (1982) factors affecting recall

Answer 3

Diagnosis vs instructions
Anxiety 
Patient factors (family) 
Perceived importance of statement
Number of statements

Question 4

Ley’s cognitive hypothesis of compliance (1982)

Answer 4

Understanding and memory = satisfaction= compliance

Question 5

Ley’s 7 recommendations to improve recall (some):

Answer 5

Instructions and advice, stress importance of it, simplify, framework, repeat info, specific advice

Question 6

Doctor-patient communication research includes

Answer 6

Observing doctors do it, intervening to get patients more involved and intervention by health professionals to empower patients

Question 7

Observing how doctors do it (Law and Britten, 1995)

Answer 7

41 GPs, taped consultation.

Female better service from women GPs, men= both

Question 8

Intervening to get patients involved (Rotter, 1977)

Answer 8

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

Question 9

Intervening to get patients involved (Greenfield et al., 1985)

Answer 9

Patients prepared and were 2x more effective in obtaining info, more active role in medical decision making

Question 10

Intervening to get patients involved (Thompson et al., 1990)

Answer 10

Write 3 Q’s to doctor and asked more q’s, were significantly less anxious than control

Question 11

Intervention by health professionals to empower patients (Kummonth et al., 1998)

Answer 11

Patient-centred training RCT= patients more satisfied with treatment and greater well being but gained more weight

Question 12

Patient and doctors hidden fears for consultations (Fischer and Ereaut, 2012)

Answer 12

Existential anxiety, entitlement anxiety and interaction anxiety

Question 13

Important role for health psychologists (2)

Answer 13

Help to develop feasible, effective interventions

Emphasise importance of patient perspective

Question 14

Measuring health status: stats limitation

Answer 14

Not specific to group and questions are too broad

Question 15

Measuring health status: bio markers

Answer 15

Many diseases where bio markers not available e.g MS

Question 16

Measuring health status : QoL

Answer 16

Overall satisfaction with life, specific domains of life

Question 17

Health related QoL

Answer 17

Values, health concepts such as functioning affected by disease and treatment

Question 18

WHO factors of QoL

Answer 18

Physical health, psychological health, levels of independence, social relationships, relationship to environment, spirituality

Question 19

A generic measure of HRQoL

Answer 19

Medical Outcomes Study Short form (SF-36)

Question 20

Limitations of SF-36 (generic measure of HRQOL)

Answer 20

May be affected by some more than others, individual differences, limitations may not be comfortable to disclose

Question 21

Advantages of generic measures e.g (SF-36)

Answer 21

Can compare scores across different diseases and to other samples

Question 22

Disease specific measures are

Answer 22

Designed for particular group, sensitive to small, clinically important changes, more familiar items

Question 23

Example of disease specific measure of HRQOL

Answer 23

MS Impact scale-29 (MSIS-29)

Question 24

Evaluation of disease specific measures

Answer 24

People with MS theoretically more pertinent than generic measures and can see where resources can be targeted Riazi et al (2003)

Question 25

Individualised measures of HRQOL example

Answer 25

Schedule for the evaluation of individual QOL

Question 26

What is the schedule for the evaluation of individual QOL?

Answer 26

Semi structured interview to elicit 5 areas of life most important to their QOL (0-100 scale)

Question 27

schedule for the evaluation of individual QOL evaluation

Answer 27

Takes into a con specific, relevant info but would only benefit small population

Question 28

Potential applications for HRQOL measures

Answer 28

Drug testing, advances in psychometrics

Question 29

Patient-centredness (Bryne and Long, 1976)

Answer 29

Preferred style of Doctor patient communication as a means to improve patient outcomes

Question 30

What does a doctor expect from a patient?

Answer 30

Explain symptoms clearly, explain behaviour, listen, take control of symptoms

Question 31

Savage-Armstrong (1990) criticism of patient centredness?

Answer 31

359 random patients, direct approach= more satisfied than sharing