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Author, Year Setting, Country Patient Group Health Outcome Patients Entered No. Treatment Allocation* Outcome Assessment† Duration Percent Lost to Follow-up USA = United States of America; OPD = outpatient department; Aus = Australia; UK = United Kingdom; GP = patient attending in general/family practice; CHD = coronary heart disease. * Allocation concealment at treatment allocation was adequate if a clear method (for example central randomization, sealed envelopes or random numbers) was reported. † Allocation concealment at outcome assessment was adequate if it was reported that assessors were unaware of participants’ study group allocation. ‡ Numbers of patients analyzed in the trial. Interventions delivered directly to patients Greenfield et al, 198522 Hospital OPD, USA Chronic disease (peptic ulcer) Subjective 45 Inadequate Adequate 8 weeks <30 Greenfield et al, 198814 Hospital OPD, USA Chronic disease (diabetes) Objective 73 Inadequate Adequate 12 weeks <30 Kaplan et al, 198921 Hospital OPD, USA Chronic disease (hypertension) Objective 105 Inadequate Inadequate 12 weeks Missing Thompson et al, 1990a20 Primary care, USA Other disease (gynecology) Subjective 66 Adequate Inadequate Immediate >30 Thompson et al, 1990b20 Primary care, USA Other disease (gynecology) Subjective 105 Adequate Inadequate Immediate >30 Butow et al, 199423 Hospital OPD, Aus Other disease (cancer) Subjective 142 Inadequate Inadequate 3 weeks >30 Street et al, 199524 Hospital OPD, USA Other disease (breast cancer) Subjective 60 Inadequate Inadequate 1 week <30 McCann & Weinman, 199625 Primary care, UK GP non specific disease Satisfaction 120 Adequate Adequate Immediate <30 Davison & Degner, 199726 Hospital OPD, Canada Other disease (prostate cancer) Subjective 60 Adequate Inadequate 6 weeks <30 Kravitz et al, 199727 Primary care, USA Other disease (not specified) Satisfaction 396 Inadequate Inadequate Immediate <30 Fleissig et al, 199928 Hospital OPD, UK Other disease (not specified) Satisfaction 1,683 Inadequate Adequate Immediate >30 Interventions delivered via practitioners Thomas, 197829 Primary care, UK GP nonspecific disease Subjective 200 Inadequate Inadequate 1 month <30 Schulman & Swain, 198030 Hospital OPD, USA Chronic disease (hypertension) Satisfaction 105 Inadequate Inadequate Immediate <30 Evans et al, 198731 Primary care, Aus GP nonspecific disease Subjective 400‡ Inadequate Inadequate 4 weeks Missing Thomas, 198732 Primary care, UK GP nonspecific disease Subjective 200 Inadequate Inadequate 2 weeks <30 Olsson et al, 198933 Primary care, Sweden GP nonspecific disease Subjective 100 Adequate Adequate 2 days <30 Savage, 199039 Primary care, UK GP nonspecific disease Subjective 350 Inadequate Inadequate 1 week >30 Evans et al, 199235 Hospital OPD, Aus Other disease (not specified) Satisfaction Missing Inadequate Adequate Immediate Missing Roter et al, 199513 Primary care, USA GP non specific disease Subjective 648 Inadequate Adequate 6 months <30 Smith et al, 199536 Primary care, USA Other disease (not specified) Satisfaction 181 Adequate Inadequate Immediate Missing Meland et al, 199737,38 Primary care, Norway Risk of disease (CHD) Objective 127 Inadequate Inadequate 1 year <30 Kinmonth et al, 199839 Primary care, UK Chronic disease (diabetes) Objective 360 Adequate Adequate 1 year >30 Pill et al, 199840 Primary care, UK Chronic disease (diabetes) Objective 190 Adequate Adequate 18 months <30 Smith et al, 199841 Primary care, USA GP nonspecific disease Subjective Missing Inadequate Adequate 4 weeks Missing Peters et al, 199942 Primary care, UK Other disease (cervical dysplasia) Subjective 270 Adequate Adequate 4 months <30 Thom et al, 199943 Primary care, USA GP nonspecific disease Other health related 414 Inadequate Inadequate 6 months <30 Brown Betz et al, 199944 Primary care, USA GP nonspecific disease Satisfaction 4,941‡ Adequate Adequate 3 months <30 Interventions delivered both to the patient and to the practitioner Lewis et al, 199145 Primary care, USA GP nonspecific disease Subjective 141 Inadequate Adequate Immediate Katon et al, 199546 Primary care, USA Chronic disease (depression) Subjective 217 Inadequate Adequate 7 months Rubenstein et al, 199547 Primary care, USA GP nonspecific disease Subjective 557 Adequate Adequate 6 months Joos et al, 199648 Hospital OPD, USA Chronic disease (not specified) Other health related 409 Inadequate Inadequate 12 months <30 Hornberger et al, 199749 Primary care, USA GP nonspecific disease Subjective 201 Inadequate Inadequate Immediate <30 Wagner et al, 199750 Hospital OPD, USA Chronic disease (epilepsy) Satisfaction 163 Adequate Inadequate Immediate <30 Maly et al, 199951 Primary care, USA Chronic disease not specified) Subjective 265 Adequate Adequate 2 weeks <30 Reuben et al, 199952 Community, USA Other disease (multiple types) Objective 363 Adequate Adequate 15 months <30 Author, Year Intervention Group Comparison Group Interventions delivered directly to patients Greenfield et al, 198522 Preconsultation interview, skills training and materials Preconsultation interview about disease course, treatment, self-care, and adherence to treatment Patient activation with attention to emotion and provision of information about treatment decisions Greenfield et al, 198814 Preconsultation interview, skills training and materials Preconsultation interview about disease course and treatment Patient activation with attention to emotion and provision of information about treatment decisions Kaplan et al, 198921 Preconsultation interview, skills training and materials Preconsultation interview about disease course, treatment, and self-care Patient activation with attention to emotion and provision of information about treatment decisions Thompson et al, 1990a20 Preconsultation, list of possible health concerns, and leaflet encouraging question asking Usual care and questionnaire on waiting room facilities Patient activation Thompson et al, 1990b20 Preconsultation, message from physician encouraging question asking, or checklist of information to be obtained during consultation Usual care and questionnaire on waiting room facilities Patient activation Butow et al, 199423 Preconsultation, leaflet encouraging question asking Handout on cancer services available Patient activation Street et al, 199524 Multimedia program providing information about disease and treatment and encouragement to ask questions, explain concerns, and offer opinion in consultation Given same material in brochure form without treatment options. Patient activation with provision of information about disease and treatment and attention to emotion McCann & Weinman, 199625 Preconsultation, leaflet encouraging questions, and ideas about causes, diagnosis, and treatment leaflet giving dietary advice Patient activation Davison & Degner, 199726 Preclinic interview facilitating provision of information, encouraging questions and participation in decisions Social interview and unfacilitated information pack Patient activation and provision of information about disease Kravitz et al, 199727 Preconsultation, patient completes request for services and is interviewed on expectations for care in consultation Usual care Patient activation Fleissig et al, 199928 Preconsultation help card, and encouragement to ask questions Usual care Patient activation Interventions delivered via practitioners Thomas, 197829 During consultation, provision of positive information about diagnosis and treatment Given positive information that there was no illness Changes style of information giving Schulman & Swain, 198030 During consultation, practitioner provided information about hypertension and its management alone, or with contingency contracting Usual care Provision of information about disase and discussion of behavior change Evans et al, 198731 Lecture, booklet, discussion Usual care Communication skills training Thomas, 198732 During consultation, certainty about diagnosis, treatment and prognosis Uncertainty about diagnosis Changes style of information giving Olsson et al, 198933 During consultation, positive style, personal, with provision of information about disease (prognosis) Less positive diagnosis, less personal, no information on prognosis Changes style of information giving and provides information about disease Savage, 199039 During consultation, shared style, eliciting patients ideas about symptoms, diagnosis, and treatment Directive style, giving clear information on diagnosis, treatment and prognosis Changes style of information giving Evans et al, 199235 Lectures small groups and videotape feedback Usual clerking Communication skills training Roter et al, 199513 Course with simulated psychiatric patients and videos Usual practice Communication skills training with attention to emotion and information about disease management Smith et al, 199536 Communication skills training with discussion of behavior change and skills in disease management Usual care Meland et al, 199737,38 Training using video and cognitive self-help materials for patients Discussion of behavior change Usual care and leaflets Kinmonth et al, 199839 Communication skills training in listening, eliciting patient’s agenda, and supporting behavior change Usual care and provision of information on disease Communication skills training, patient activation with attention to emotion, and discussion of behavior change Pill et al, 199840 Practice based training in eliciting patient concerns and discussing behavior change Usual care Communication skills training, patient activation with attention to emotion, and discussion of behavior change Smith et al, 199841 Course of seminars, video and booklets on communication, and disease management skills Usual care Communication skills training with attention to emotion, discussion of behavior change Peters et al, 199942 Information leaflets and invitation to consult practice nurse who was trained to present information on disease, risk, and treatment and encourage women to ask questions Disease information leaflet Patient activation and information about disease management Thom et al, 199943 Workshop Usual care Communication skills training with patient activation and attention to emotion Brown Betz et al, 199944 Workshops Usual practice Communication skills training program with attention to emotion Interventions delivered both to the patient and to the practitioner Lewis et al, 199145 Separate communication skills training sessions, videos and materials for patients and practitioners Course on bicycle safety (patient) assessment of febrile child (practitioner) Child patient and parent activation and practitioner communication skills teaching, with attention to emotion Katon et al, 199546 Videos and materials on cognitive-behavioral management of depression and encouraging question asking. Practitioner course on treatment of depression and case-based feedback Usual care Patient activation, information about disease management and discussion of behavior change Rubenstein et al, 199547 Patients completed functional status questionnaire preconsultation, practitioners taught questionnaire interpretation Usual care Patient activation, practitioner activated by patient questionnaire Joos et al, 199648 Preconsultation, patient completes request for service form, practitioners taught communication skills Usual care Patient activation, practitioner activated by patient questionnaire with attention to emotion, and communication skills training Hornberger et al, 199749 Preconsultation, patient completes request for services form including emotional needs Usual care Patient activation, practitioner activated by patient questionnaire, with attention to emotion Wagner et al, 199750 Preconsultation; patients completed functional status questionnaire in consultation, practitioners taught interpretation Usual care Patient activation, practitioner activated by patient questionnaire, with attention to emotion Maly et al, 199951 Preconsultation; patient recorded two questions which were attached to the medical record, given medical notes and glossary Information sheet and patient suggestion list Patient activation, information about disease, and practitioner activated by patient note Reuben et al, 199952 Specialist advice to practitioners via telephone; provision of information about disease and its treatment. Preconsultation booklet and telephone call to patient Usual care and nonstudy incentives Patient activation and information about disease management Author, Year Objective Health Outcomes (Disease Processes)* Subjective Health Outcomes (Illness Experience) Other Outcomes Satisfaction HbA1c = glycosylated hemoglobin; ++ = result significantly favors intervention group; + = result favors intervention group; – – = result significantly favors control group; – = result favors control group; 0∞ = outcome identical in both groups; cost = health services cost. Note: Principal outcome for each study in boldface; not analyzed = results not reported in original paper; missing = no data presented in the paper. * Physiology, survival, mortality. † No significant difference reported with no further data presented. Interventions delivered directly to patients Greenfield et al, 198522 Pain: + Knowledge: – – – Functional status: ++ Cost: + Greenfield et al, 198814 HbA 1c : ++ Quality of life: ++ Knowledge: + – Functional status: ++ Cost: ++ Kaplan et al, 198921 Blood pressure: ++ Functional status: ++ Cost: missing Missing Well-being: missing Thompson et al, 1990a20 Anxiety: ++ Cost: + 0∞ Thompson et al, 1990b20 Anxiety: + Knowledge: checklist – ++ Message + Butow et al, 199423 Quality of life: 0∞ Knowledge: – – Street et al, 199524 Well-being: 0 † Knowledge: + McCann & Weinman, 199625 Cost: – – + Davison & Degner, 199726 Anxiety: + Depression: + Kravitz et al, 199727 0 † Fleissig et al, 199928 ++ Interventions delivered via practitioners Thomas, 197829 Symptom resolution: – Schulman & Swain, 198030 + Evans et al, 198731 Anxiety: ++ ++ Thomas, 198732 Symptom resolution: ++ Olsson et al, 198933 Symptom resolution: ++ Cost: not analyzed ++ Savage, 199039 Symptom resolution: – Cost: – – – Evans et al, 199235 Cost: 0† ++ Roter et al, 199513 Depression: ++ Cost: – Smith et al, 199536 ++ Meland et al, 199737,38 Blood presure: + Quality of life: + Health behavior: exercise + – – Cholesterol: + Well-being: + Smoking 0† Thiocyanate:+ Functional status: + Cost: + Kinmonth et al, 199839 HbA 1c : + Quality of life: + Health behavior: diet 0† ++ Cholesterol: – Well-being: ++ Triglyceride – – Exercise/smoking - Body mass index: – – Knowledge: – – Blood pressure: – Albumin/creatine: – Pill et al, 199840 HbA 1c : – Diabetic complication:+ Health behavior: 0† – – Blood pressure: – Functional status: – – Cost: 0† Body mass index: – Well-being: 0† Smith et al, 199841 Depression: + Knowledge: missing + Functional status: + Peters et al, 199942 Perceptions of health: – Health behavior: + Anxiety: + Cost: – – Functional status: + Thom et al, 199943 Health behavior: 0 † + Cost: 0† Brown Betz et al, 199944 – Interventions delivered both to the patient and to the practitioner Lewis et al, 199145 Anxiety: + Knowledge: ++ ++ Katon et al, 199546 Depression: + Health behavior: ++ ++ Functional status: missing Rubenstein et al, 199547 Functional status: ++ Joos et al, 199648 Health behavior: medication – + Appointments: 0∞ Hornberger et al, 199749 Depression: + Cost: – – + Anxiety: ++ Functional status: 0† Wagner et al, 199750 Cost: – + Maly et al, 199951 Functional status: ++ Health behavior: + Cost: + Reuben et al, 199952 Mortality: + Functional status: ++ +
Supplemental Tables
Table 2a. Effects of Interventions on Process of Consultations; Table 4. Summary of Relationships Between Intervention Categories and Health Outcomes
Files in this Data Supplement:
- Supplemental data: Table 2a - PDF file, 2 pages, 41 KB
- Supplemental data: Table 4 - PDF file, 1 page, 66 KB
The Article in Brief
Communication between doctors and patients is an important part of medical care. A limited amount of research has examined methods for changing the way that doctors and patients communicate in an office visit and how those methods affect patient health. A new study summarized this research and found that many approaches can influence communication between doctors and patients, and may improve patient health.
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