Article Figures & Data
Tables
1. Doctor responds to feelings 2. Doctor praises or encourages 3. Doctor uses patient’s ideas 4a. Doctor asks open-ended question 4b. Doctor asks closed-ended question 5. Doctor gives information 6. Doctor gives instructions 7. Doctor criticizes or justifies his or her authority 8. Patient responds to doctor 9. Patient initiates (question or information) 10. Silence or confusion Note: For this study, categories 1 through 7 were combined to determine total physician talk time, and categories 8 and 9 were combined for patient talk time. More detailed analyses of the categories were not used.
Questions Answers (Examples) Control group Which symptoms or problems are bothering you the most lately? Leg, pain with walking
Back pain, back spasms
Fibromyalgia; arthritis
Dizziness, neuropathy
Diabetes, foot pain
Eyes floaters, stomach-diarrhea
ADHD medication
Bone infection
Toenail fungusIntervention Group 1. What things are you unable to do as a result of your health problems? Flowering/gardening, taking shower by self
Get comfortable, get dressed, take shower, cook, walk, roll over
Most things, sadly; anything with exertion2. What other things would you like to be able to do that you can’t do now? Get dressed, stand and walk to cook
Have a better memory for everyday things, school life, etc.
Cooking on my own, doing things my way when I want to3. What activities make life worthwhile for you (that you wouldn’t want to have to give up)? Doing my own thing, go to bedroom from bathroom
Taking care of my son, bathing self, being able to walk outside
Spending time with loved onesOutcome Measure Control (n = 32) Intervention (n = 32) P Value Patient’s QOL goals or concerns were mentioned, No. 0 2 NSa Patient’s QOL goals or concerns were discussed during clinical decision-making, No. 0 0 NSa Modified Carkhuff-Truax Scale Scores Empathy, mean score 2.92 2.53 .01 Attendance, mean score 2.75 2.88 NSb Congruence, mean score 2.69 2.81 NSb Positive regard, mean score 2.66 2.50 NSb Modified Flanders Assessment Tool Results, % (SD) Portion of visit taken up with physician talk 48.0 (0.11) 48.6 (0.15) NSc Portion of visit taken up with patient talk 38.8 (0.11) 36.8 (0.14) NSc
Additional Files
The Article in Brief
Encouraging Patient-Centered Care by Including Quality-of-Life Questions on Pre-Encounter Forms
Becky A. Purkaple , and colleagues
Background Patient participation in clinical decision-making improves outcomes including quality of life (QOL). Yet physicians tend to focus on diseases and symptoms rather than patient-oriented outcomes, such as the ability to participate in meaningful life activities. This study explores whether patients can encourage primary care physicians to pay attention to their QOL goals by writing them on pre-encounter forms. Studying whether patients could encourage their primary care physicians to be more patient-centered by using pre-encounter forms to alert their physicians to quality of life goals and concerns
What This Study Found The intervention questionnaire led to little focus on quality of life during physician visits, when compared to a questionnaire that simply asked about symptoms. Although patients effectively articulated their quality of life goals on paper, quality of life was mentioned in only two of 64 encounters, once by a patient and once by a physician. In neither case was the QOL information used in decision making. Furthermore, directly observed empathy was greater in encounters in the control group, compared to the intervention group.
Implications
- Recording QOL goals on paper does not prime patients or physicians to alter the process or content of clinical encounters and suggests that QOL information is hard to incorporate into the patient encounter.
- With previous research showing that patient participation in clinical decision making improves outcomes, including quality of life, the authors call for training and pre-visit coaching for both patients and physicians to adopt this new behavior.
