Patient-initiated questions: How can doctors encourage them and improve the consultation process? A qualitative study

Abstract

ObjectiveTo investigate the circumstances under which patients initiate direct questions in oncology consultations.DesignConversation analysis of 47 consultations between oncologists and patients with cancer.SettingAn oncology clinic at a teaching hospital in the East Midlands.Participants16 Oncologists and 67 cancer patients.Outcome measurePatient initiated direct questions.ResultsOn the whole patients’ direct questions are designed to seek specific information regarding, the cancer itself, treatment options or their experience of symptoms. When patients do ask direct questions they typically follow the announcement of test results where some reference to the details of those results, is provided. More specifically, there seems to be a relation between showing the patient their scan/X-ray results, patient involvement and patient-initiated direct questions. Higher levels of patient-initiated direct questions were clustered around occasions where doctors provided information and explanations of test results (12 consultations) sometimes with direct reference to scan or X-ray results (7 consultations).ConclusionsThis study highlights the importance of careful explanation of diagnostic evidence as a factor contributing to increased patient involvement. More specifically, the findings suggest that, when appropriate, invoking diagnostic evidence (eg, scan or X-ray results) is an effective way of increasing levels of patient question asking. Doctors need to be able to encourage patient question asking to ensure that patients have at their disposal an important means through which they can determine their information needs. Although these results come from a study of oncology consultations, the findings may be transferable to other clinical contexts.

Improving consultations in oncology: the development of a novel consultation aid

“…Moreover, reviewing digital images also enabled patients to ask their questions and at times aided understanding. This finding was verified in our analysis of the consultation data, which revealed that, almost invariably, patient-initiated questions followed when doctors invoked scan or X-ray results in the consultation process (Murtagh et al , 2013).

‘I understood what he was talking about and he showed me the scan.

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Delivering patient choice in clinical practice: a conversation analytic study of communication practices used in neurology clinics to involve patients in decision-making

“…The authors conclude that: 'Incorporating and explaining the evidence appears to be interpreted by patients as an opportunity to contribute to the consultation and establish their information needs in an environment within which the patient's queries/opinions are welcomed' (p. 5). 24 This was of particular significance in the study setting as the authors also found that, in general, patients' levels of involvement were relatively low, and that patients seemed largely 'disinclined to ask questions' (p. 5).…”

“…23 These findings have a close parallel in data collected in secondary care cancer consultations in the UK. Focusing on discussions of test results, Murtagh et al 24 found evidence of a relationship between the way in which the results were delivered and whether or not patients asked direct questions. 'Plainer' announcements, which did not include sharing of the diagnostic evidence (e.g.…”

“…[41][42][43] In addition, as we discussed in the previous section, there is a handful of studies that have demonstrated how the turn designs selected by doctors can be more or less conducive to subsequent patient participation. 9,[22][23][24] However, CA studies of decision-making in clinical practice have rarely investigated the ways in which doctors might actively invite patients to participate. Instead, as we discuss next, the focus has been predominantly on doctors' recommendations.…”

“…withdrawing all medication; see lines 12 and 13) is 'another thing' they could add to the list (see line 18), he goes on to reiterate his version (i.e. continuing with the current dose of azathioprine, lines [22][23][24][25][26]. He thereby makes it apparent that he is not in favour of the patient's proposal.…”