Improving general practitioners’ interviewing skills in managing patients with depression and anxiety: a randomized controlled clinical trial

Abstract

Background: Studies regarding the effectiveness of CME programmes on physicians' behaviour and communication skills showed inconsistent results. Few randomized controlled trials have been conducted in Asia. Methods: To evaluate the effectiveness of a 4 2-hour education programme to improve GP interviewing behaviours, 16 general practitioners were randomized to the intervention and control groups, respectively. Physicians assigned to the intervention group received 8 hours of training emphasizing interviewing behaviours in the diagnosis and treatment of depression and generalized anxiety disorders (GDS). Those assigned to the control group did not receive any training until the completion of study. Standardized patients were used to evaluate the performance of physicians. Two consultations before and after enrolling in the education programme were videotaped. Independent evaluations of consultations were made by a trained clinical psychologist and a social worker blinded to the study status of physicians. The rating schedule for the videotapes was based on the tasks listed on the Calgary Cambridge Observation Guide. Results: The change of score between the intervention and control physicians was significantly different in 'active listening and facilitating patients' response' (p ¼ 0.011) with the intervention physicians having improvement of score. For 'non-verbals', 'understanding patient's perspective' and 'negotiating mutual plan of action', positive change of score in the intervention physicians were seen when compared to that of the control, although the difference did not reach statistical significance (p ¼ 0.06, p ¼ 0.05, p ¼ 0.06, respectively). However, for 'opening', 'structuring the consultation', 'explanation and planning' and 'closure', there were no statistical significant differences between control and intervention group. Conclusions: Our results showed that only certain communication skills, such as active listening and facilitating patient's response, can be taught in the management of depression and generalized anxiety disorder (GAD) in Chinese primary care physicians.

Understanding Cultural Influences on Depression by Analyzing a Measure of Its Constituent Symptoms

“…Physical symptoms of depression are mild and curable, while psychological ones are more serious (e.g., Bjorkman, Svensson, & Lundberg, 2007;Kalkhoff, Djurich, & Burke, 2007;Wright et al, 2007). Thus, it is not surprising that there are many misdiagnoses of Chinese people by American diagnosticians, as their Chinese patients tend to express somatic symptoms including boredom, discomfort, and dizziness rather than the other symptoms of depression (e.g., Schnyer et al, 2005;Wong et al, 2007).…”

“…In consequence, American and American-trained clinicians may misdiagnose the depressive disorder among Chinese immigrants based on Western psychiatric theory if they fail to calibrate their diagnosis to the culturally channeled expression of symptoms. That may be why a lower prevalence of depression is sometimes reported among Chinese compared to persons from other parts of the world, predominantly America (e.g., Chan et al, 2007;Zhang, Shen, & Li, 1998). …”

A Qualitative Exploration of Service Users’ Information Needs and Preferences When Receiving a Serious Mental Health Diagnosis

“…As diagnosis can be a challenging time for individuals (Cleary et al 2010a), their families (Greenwood et al 2000) and clinicians (Cleary et al 2010b) calls have been made to improve clinician competencies and confidence when initially discussing a diagnosis by providing training (Cleary et al 2010b;Gerrity et al 1999;Jha et al 2001;Luderer and Bocker 1993;Milton and Mullan in press;Scardovi et al 2003;Shergill et al 1998;Wong et al 2007) and developing protocols (Cleary et al 2009;Milton and Mullan in press). To address this need, a step-wise model of breaking news borrowed from oncology has been advocated [SPIKES protocol;See (Baile et al 2000;Cleary et al 2010a) and Table 2], and a model specifically tailored to discussing a schizophrenia diagnosis has been developed [See (Levin et al 2011) and Table 2].…”

Communication of a mental health diagnosis: a systematic synthesis and narrative review

“…Sequence generation was not sufficiently described in both trials. Risk of bias for concealment of the allocation sequence was low (Gerrity et al, 1999) or unclear (Wong et al, 2007). For both studies, blinding of assessors and participants created a low risk of bias, as did missing data (i.e.…”

“…Most studies were descriptive (level IV-2), thus weaker evidence strength should be considered when interpreting results. The risk of bias rating (Higgins et al, 2011) is presented in Figure 2 for the RCT studies (Gerrity et al, 1999;Wong et al, 2007). Sequence generation was not sufficiently described in both trials.…”