Improving Communication in Outpatient Consultations in People With Cirrhosis

Low, Joseph; Davis, Sarah; Greenslade, Lynda; Carroll, C.; Craig, Rachel; Wilson, Jo; Clancy, Jennifer-Louise; Marshall, Aileen; Thorburn, Douglas; Stone, Patrick

doi:10.1097/mcg.0000000000001347

Cited by 8 publications

(6 citation statements)

References 17 publications

(19 reference statements)

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“…Verbal endorsement of question‐asking alone may not increase question asking by the patient, 24–27 so other methods such as the introduction of Question Prompt Lists (QPLs) should be considered. QPLs are a list of prompting questions that may be relevant to the patient during their consultation, 28 and they are a favourable communication tool by both patients and doctors 28–30 . QPLs increase the number of questions asked by the patient and have minimal impact on consultation time 31 …”

Section: Discussionmentioning

confidence: 99%

“…QPLs are a list of prompting questions that may be relevant to the patient during their consultation, 28 and they are a favourable communication tool by both patients and doctors. [28][29][30] QPLs increase the number of questions asked by the patient and have minimal impact on consultation time. 31 Time-pressures perceived by patients through the surgeons' conduct could prevent patients asking questions.…”

Section: Surgeon/consultation Factorsmentioning

confidence: 99%

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Do you have any questions? An analysis of question asking patterns in surgical outpatient consultations

Ting

Reid

Treloar

et al. 2022

ANZ Journal of Surgery

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Background: Patient centred communication ensures patients are well informed and educated, which is vital to providing the best care possible. By asking questions, patients can better understand their disease and make informed decisions regarding their health journey. We aimed to investigate factors that affect question asking behaviours in surgical outpatient consultations and to determine the typical question-asking by doctors, patients, and their companions. Methods: This is an observational cross-sectional study, where 182 video recordings of surgical consultations in the surgical outpatient setting at The Queen Elizabeth Hospital, Adelaide, South Australia were reviewed. Results: A total of 3472 questions were asked. Most questions were asked by the surgeon, followed by the patient, and if present, their companion. Pre-surgical consultations resulted in the most questions asked by the patients, compared to post-surgical or follow-up consultations. When companions were present, patients asked more questions in consultants regarding malignant conditions. Interruptions increased the number of questions asked by the patient and their companion. Questions were commonly asked to clarify information given by the surgeon and often regarded the cause of the illness and the timing of the next step in disease management. Conclusion: Patients are generally interested in their health and ask questions during consultations. Companions have a positive effect on patient question asking behaviour and their presence in surgical consultations should be encouraged. Surgeons should develop strategies to encourage question asking and could review their own behaviours via surgical coaching and video review.

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Section: Discussionmentioning

confidence: 99%

Section: Surgeon/consultation Factorsmentioning

confidence: 99%

Do you have any questions? An analysis of question asking patterns in surgical outpatient consultations

Ting

Reid

Treloar

et al. 2022

ANZ Journal of Surgery

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“…However, decisions regarding life-prolonging treatments are also relevant for patients with other advanced diseases, such as advanced stages of chronic obstructive pulmonary disease, chronic heart failure, 45 chronic kidney disease 46 or liver disease. 47 It is known that in adults with advanced diseases, options for starting, stopping or forgoing life-prolonging treatments are often discussed only at a late stage due to discomfort about addressing end-of-life issues and uncertainty about the timing of such discussions. 16 45 48 Besides, healthcare professionals are often uncertain about how to address a poor prognosis or a short life expectancy, which might result in them avoiding these topics, even though those conversations may have consequences for treatment decisions.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and effectiveness of tools that support communication and decision making in life-prolonging treatments for patients in hospital: a systematic review

Thodé

Pasman

Vliet

et al. 2020

BMJ Support Palliat Care

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ObjectivePatients with advanced diseases and frail older adults often face decisions regarding life-prolonging treatment. Our aim was to provide an overview of the feasibility and effectiveness of tools that support communication between healthcare professionals and patients regarding decisions on life-prolonging treatments in hospital settings.DesignSystematic review: We searched PubMed, CINAHL, PsycINFO, Embase, Cochrane Library and Google Scholar (2009–2019) to identify studies that reported feasibility or effectiveness of tools that support communication about life-prolonging treatments in adult patients with advanced diseases or frail older adults in hospital settings. The Mixed Methods Appraisal Tool was used for quality appraisal of the included studies.ResultsSeven studies were included, all involving patients with advanced cancer. The overall methodological quality of the included studies was moderate to high. Five studies described question prompt lists (QPLs), either as a stand-alone tool or as part of a multifaceted programme; two studies described decision aids (DAs). All QPLs and one DA were considered feasible by both patients with advanced cancer and healthcare professionals. Two studies reported on the effectiveness of QPL use, revealing a decrease in patient anxiety and an increase in cues for discussing end-of-life care with physicians. The effectiveness of one DA was reported; it led to more understanding of the treatment in patients.ConclusionsUse of QPLs or DAs, as a single intervention or part of a programme, may help in communicating about treatment options with patients, which is an important precondition for making informed decisions.

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“…Use of a question prompt list, a recommended set of questions that patients and their family can review prior to an outpatient visit regarding their medical care, has been shown to improve communication among providers, patients, and families [47]. A question prompt list has recently been developed for patients with advanced liver disease and could provided to patients in the outpatient setting prior to a clinic appoint to empower them to express their unmet informational needs [48]. Use of visual aids such as the "Best case/Worst case" communication tool to provide anticipatory guidance for patients with advanced liver disease should be considered and has been shown to be effective in shared decision-making and ACP in patients with serious illnesses [41 Collaborating with specialty palliative care services in the outpatient setting may be helpful to clarify patients' goals and values early in their disease course.…”

Section: How To Integrate Early Acp Into Outpatient Hepatology Clinical Practicementioning

confidence: 99%

Advance Care Planning and Goals of Care Discussions in Advanced Liver Disease

Ufere

2021

Curr Hepatology Rep

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Purpose of Review Advance care planning (ACP) has been shown to improve multiple outcomes in patients with serious illnesses; however, patients with advanced liver disease, or cirrhosis, rarely receive timely ACP. The purpose of this review is to evaluate the current state of ACP for patients with advanced liver disease and to provide practical guidance for integrating early ACP into routine outpatient hepatology care. Recent Findings Due to multiple patient-, physician-, and systems-level barriers, patients with advanced liver disease have low rates of timely ACP engagement. Early identification and preparation of a surrogate decision-maker, enhancing clinician ACP communication skills, use of patient-centered educational tools, optimizing outpatient processes for ACP documentation, and early referral to specialty palliative care may help to improve current deficits in ACP for this population. Summary Provision of early ACP to patients with advanced liver disease may better ensure that patients receive medical care that is consistent with their goals and values.

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Improving Communication in Outpatient Consultations in People With Cirrhosis

Abstract: Supplemental Digital Content is available in the text.

Cited by 8 publications

References 17 publications

Do you have any questions? An analysis of question asking patterns in surgical outpatient consultations

Do you have any questions? An analysis of question asking patterns in surgical outpatient consultations

Feasibility and effectiveness of tools that support communication and decision making in life-prolonging treatments for patients in hospital: a systematic review

Advance Care Planning and Goals of Care Discussions in Advanced Liver Disease

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