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

Kinnersley P, Edwards A, Hood K, Ryan R, Prout H, Cadbury N, MacBeth F, Butow P, Butler C - BMJ (2008)

Bottom Line: 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.Interventions for patients before consultations produce small benefits for patients.

View Article: PubMed Central - PubMed

Affiliation: Neuadd Meirionydd, School of Medicine, Cardiff University, Cardiff CF14 4XN. kinnersley@cf.ac.uk

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.

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Related in: MedlinePlus

Fig 3 Effect on patients’ anxiety before consultations of interventions to encourage patients to ask questions in consultations
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fig3: Fig 3 Effect on patients’ anxiety before consultations of interventions to encourage patients to ask questions in consultations

Mentions: Anxiety before consultations was measured in four studies.w1 w5 w9 w24 Two studiesw5 w24 found a reduction in anxiety, onew9 an increase, and onew1 no effect. Meta-analysis of the three studies with extractable date showed a large but non-statistically significant decrease in patients’ anxiety (weighted mean difference −1.56, −7.10 to 3.97; table 2 and fig 3). In nine studiesw3 w6 w7 w13 w19 w22 w28 w34 anxiety was measured after the index consultation, with two studiesw19 w34 reporting a reduction in patient anxiety, onew7 an increase, and sixw3 w6 w13 w22 w28 w34 no effect. Meta-analysis of the six studies with extractable data showed a small and non-statistically significant decrease (standardised mean difference −0.08, −0.22 to 0.06; table 2 and fig 4).


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

Kinnersley P, Edwards A, Hood K, Ryan R, Prout H, Cadbury N, MacBeth F, Butow P, Butler C - BMJ (2008)

Fig 3 Effect on patients’ anxiety before consultations of interventions to encourage patients to ask questions in consultations
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2500196&req=5

fig3: Fig 3 Effect on patients’ anxiety before consultations of interventions to encourage patients to ask questions in consultations
Mentions: Anxiety before consultations was measured in four studies.w1 w5 w9 w24 Two studiesw5 w24 found a reduction in anxiety, onew9 an increase, and onew1 no effect. Meta-analysis of the three studies with extractable date showed a large but non-statistically significant decrease in patients’ anxiety (weighted mean difference −1.56, −7.10 to 3.97; table 2 and fig 3). In nine studiesw3 w6 w7 w13 w19 w22 w28 w34 anxiety was measured after the index consultation, with two studiesw19 w34 reporting a reduction in patient anxiety, onew7 an increase, and sixw3 w6 w13 w22 w28 w34 no effect. Meta-analysis of the six studies with extractable data showed a small and non-statistically significant decrease (standardised mean difference −0.08, −0.22 to 0.06; table 2 and fig 4).

Bottom Line: 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.Interventions for patients before consultations produce small benefits for patients.

View Article: PubMed Central - PubMed

Affiliation: Neuadd Meirionydd, School of Medicine, Cardiff University, Cardiff CF14 4XN. kinnersley@cf.ac.uk

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.

Show MeSH
Related in: MedlinePlus