Interventions before consultations to help patients address their information needs by encouraging question asking: systematic review

Abstract

Objective To assess the effects on patients, clinicians, and the healthcare system of interventions before consultations to help patients or their representatives gather information in consultations by question asking. Design Systematic review with meta-analysis. Data sources Electronic literature searches of seven databases and hand searching of one journal and bibliographies of relevant articles. Review methods Inclusion criteria included randomised controlled trials. Main outcome measures Primary outcomes were question asking; patients' anxiety, knowledge, and satisfaction; and length of consultation. Results 33 randomised trials of variable quality involving 8244 patients were identified. A few studies showed positive effects. Meta-analyses showed small and statistically significantly increases in question asking (standardised mean difference 0.27, 95% confidence interval 0.19 to 0.36) and patients' satisfaction (0.09, 0.03 to 0.16). Non-statistically significant changes occurred in patients' anxiety before consultations (weighted mean difference −1.56, −7.10 to 3.97), patients' anxiety after consultations (standardised mean difference −0.08, −0.22 to 0.06), patients' knowledge (−0.34, −0.94 to 0.25), and length of consultation (0.10, −0.05 to 0.25). Interventions comprising written materials had similar effects on question asking, consultation length, and patients' satisfaction as those comprising the coaching of patients. Interventions with additional training of clinicians had little further effect than those targeted at patients alone for patients' satisfaction and consultation length. Conclusions Interventions for patients before consultations produce small benefits for patients. This may be because patients and clinicians have established behaviours in consultations that are difficult to change. Alternatively small increases in question asking may not be sufficient to make notable changes to other outcomes.

A pre-visit website with question prompt sheet for counselees facilitates communication in the first consultation for breast cancer genetic counseling: findings from a randomized controlled trial

“…25 Studies reviewing effects of a QPS evaluated those with example questions. 20 Provision of example questions next to space for own questions might increase counselee use of the QPS and is advised for future studies.…”

“…A question prompt sheet (QPS), which prompts patients to articulate their questions before their consultation, has been shown effective in other settings. 20 Observation studies in oncology consultations have shown that QPS use increased patient question asking, 19,21,22 especially when the QPS was actively endorsed by the physician. 19 Additionally, patients were empowered to raise topics.…”

Doctors'non-verbal behaviour in consultations: look at the patient before you look at the computer

“…12 and there is some evidence that doctors respond to increased patient participation with nonverbal blocking behaviours.…”

How should patients behave to facilitate shared decision making – the doctors’ view

“…8 The few studies that focused on patient participation or the patientsÕ side of SDM primarily deal with the notion of communicative competencies that can facilitate patient participation like asking questions, providing information and verifying it. [9][10][11] It has been argued that patients need to be more assertive in order to motivate their physicians for a more patient-centred style. 12 While there is good reason to consider these behaviours as generally helpful for SDM, in daily practice many physicians might have a different view and prefer a more paternalistic doi: 10.1111/j.1369-7625.2011.00682.x style particularly under time constraints or when in doubt about their patientsÕ decisional capacity.…”