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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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Fig 6 Effect on patients’ satisfaction of interventions to encourage patients to ask questions in consultations
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fig6: Fig 6 Effect on patients’ satisfaction of interventions to encourage patients to ask questions in consultations

Mentions: Patients’ satisfaction was measured in 23 studies. In 14 studiesw2 w4 w5-w9 w14 w19 w24-w26 w28 w34 no changes were found and in fivew16 w22 w23 w29 w30 w34 satisfaction increased.w16 w22 w23 w29 w30 w34 In two additional studies increases occurred only for particular aspects of satisfaction (depth of relationship,w27 interpersonal satisfactionw33). In one studyw3 the satisfaction of child patients was increased but parental satisfaction was unchanged. No immediate effect was found in another trial,w20 but satisfaction was increased at three months. Meta-analysis of 17 studies with extractable data for overall satisfaction immediately after consultation showed a small and statistically significant increase (standardised mean difference 0.09, 0.03 to 0.16; fig 6).


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 6 Effect on patients’ satisfaction 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

fig6: Fig 6 Effect on patients’ satisfaction of interventions to encourage patients to ask questions in consultations
Mentions: Patients’ satisfaction was measured in 23 studies. In 14 studiesw2 w4 w5-w9 w14 w19 w24-w26 w28 w34 no changes were found and in fivew16 w22 w23 w29 w30 w34 satisfaction increased.w16 w22 w23 w29 w30 w34 In two additional studies increases occurred only for particular aspects of satisfaction (depth of relationship,w27 interpersonal satisfactionw33). In one studyw3 the satisfaction of child patients was increased but parental satisfaction was unchanged. No immediate effect was found in another trial,w20 but satisfaction was increased at three months. Meta-analysis of 17 studies with extractable data for overall satisfaction immediately after consultation showed a small and statistically significant increase (standardised mean difference 0.09, 0.03 to 0.16; fig 6).

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