Patient-centred communication and Outcomes Flashcards

1
Q

Reasons for doctor communication breakdown

A

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

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2
Q

Reasons for patient communication breakdown

A

Doesn’t understand disease or treatment

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3
Q

Ley (1982) factors affecting recall

A
Diagnosis vs instructions
Anxiety 
Patient factors (family) 
Perceived importance of statement
Number of statements
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4
Q

Ley’s cognitive hypothesis of compliance (1982)

A

Understanding and memory = satisfaction= compliance

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5
Q

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

A

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

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6
Q

Doctor-patient communication research includes

A

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

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7
Q

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

A

41 GPs, taped consultation.

Female better service from women GPs, men= both

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8
Q

Intervening to get patients involved (Rotter, 1977)

A

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

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9
Q

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

A

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

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10
Q

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

A

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

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11
Q

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

A

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

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12
Q

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

A

Existential anxiety, entitlement anxiety and interaction anxiety

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13
Q

Important role for health psychologists (2)

A

Help to develop feasible, effective interventions

Emphasise importance of patient perspective

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14
Q

Measuring health status: stats limitation

A

Not specific to group and questions are too broad

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15
Q

Measuring health status: bio markers

A

Many diseases where bio markers not available e.g MS

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16
Q

Measuring health status : QoL

A

Overall satisfaction with life, specific domains of life

17
Q

Health related QoL

A

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

18
Q

WHO factors of QoL

A

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

19
Q

A generic measure of HRQoL

A

Medical Outcomes Study Short form (SF-36)

20
Q

Limitations of SF-36 (generic measure of HRQOL)

A

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

21
Q

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

A

Can compare scores across different diseases and to other samples

22
Q

Disease specific measures are

A

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

23
Q

Example of disease specific measure of HRQOL

A

MS Impact scale-29 (MSIS-29)

24
Q

Evaluation of disease specific measures

A

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

25
Individualised measures of HRQOL example
Schedule for the evaluation of individual QOL
26
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)
27
schedule for the evaluation of individual QOL evaluation
Takes into a con specific, relevant info but would only benefit small population
28
Potential applications for HRQOL measures
Drug testing, advances in psychometrics
29
Patient-centredness (Bryne and Long, 1976)
Preferred style of Doctor patient communication as a means to improve patient outcomes
30
What does a doctor expect from a patient?
Explain symptoms clearly, explain behaviour, listen, take control of symptoms
31
Savage-Armstrong (1990) criticism of patient centredness?
359 random patients, direct approach= more satisfied than sharing