Interventions before consultations for helping patients address their information needs.Summary
Interventions before healthcare consultations for helping patients get the information they require
Patients often report that they want more information from their healthcare providers or that the information they do receive does not address their needs. Generally, the amount of information given is small. People have differing needs for information, which also varies with the specific illness, but providing information is important as it helps patients recall, understand and follow treatment advice and be more satisfied. Clinicians may underestimate or undervalue the information needs of patients. They may also lack the skills to give information effectively. Training doctors and nurses probably helps, but another approach is to try to directly help patients ask questions in their consultations. This can be done by various methods such as question prompt sheets (which encourage patients to write down their questions) or coaching (when someone helps the patient to think of the questions they want to ask). This review evaluated studies of these types of interventions.
We identified 33 randomised Adj. 1. randomised - set up or distributed in a deliberately random way
irregular - contrary to rule or accepted order or general practice; "irregular hiring practices" controlled trials involving 8244 patients from six countries, mainly the USA, in a range of clinical settings. Most interventions, which included written materials (for example, question prompt sheets) and coaching sessions, were delivered in the waiting room immediately before the consultation. They were compared to dummy interventions or usual care. Health issues included primary care and family medicine, cancer, diabetes, heart problems, women's issues, peptic ulcer peptic ulcer: see ulcer.
Sore that develops in the mucous membrane of the stomach (more frequent in women) or duodenum (accounting for 80% of ulcers and more frequent in men) when its ability to resist acid in gastric juice is reduced. and mental illness.
We found small increases in question asking and patient satisfaction and a possible reduction in patient anxiety before and after consultations. We also found a possible reduction in patient knowledge and a possible small increase in consultation length. Both coaching and written materials produced similar effects on asking questions but coaching had a larger benefit in terms of patient satisfaction. Interventions immediately before the consultation led to a small increase in patient satisfaction whereas giving the intervention some time before did not. Interventions immediately before the consultation also resulted in small increases in consultation length, particularly when using written materials rather than coaching. Interventions some time before the consultation did not alter consultation time.
The interventions seem to help patients ask more questions in consultations, but do not have other clear benefits. Doctors and nurses need to continue to try to help their patients ask questions in consultations and question prompt sheets or coaching may help in some circumstances.
The Cochrane Database of Systematic Reviews 2011 Issue 1, Copyright[C] 2011 The Cochrane Collaboration The Cochrane Collaboration was developed in response to Archie Cochrane's call for up-to-date, systematic reviews of all relevant randomized controlled trials of health care. . Published by John Wiley John Wiley may refer to:
Patients often do not get the information they require from doctors and nurses. To address this problem, interventions directed at patients to help them gather information in their healthcare consultations have been proposed and tested.
To assess the effects on patients, clinicians and the healthcare system of interventions which are delivered before consultations, and which have been designed to help patients (and/or their representatives) address their information needs within consultations.
We searched: the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library The Cochrane Library is a collection of databases in medicine and other healthcare specialties provided by the Cochrane Collaboration. At its core is a database of systematic reviews and meta-analyses which summarise and interpret the results of high-quality medical research. (issue 3 2006); MEDLINE The online medical database of the U.S. National Library of Medicine (NLM) whose parent is the National Institutes of Health, Bethesda, MD. MEDLINE contains millions of articles from thousands of medical journals and publications. The consumer section of the site (http://medlineplus. (1966 to September 2006); EMBASE (1980 to September 2006); PsycINFO (1985 to September 2006); and other databases, with no language restriction. We also searched reference lists of articles and related reviews, and handsearched Patient Education and Counseling (1986 to September 2006).
Randomised controlled trials of interventions before consultations designed to encourage question asking and information gathering by the patient.
Data collection and analysis
Two researchers assessed the search output independently to identify potentially-relevant studies, selected studies for inclusion, and extracted data. We conducted a narrative synthesis of the included trials, and meta-analyses of five outcomes.
We identified 33 randomised controlled trials, from 6 countries and in a range of settings. A total of 8244 patients was randomised and entered into studies. The most common interventions were question checklists and patient coaching. Most interventions were delivered immediately before the consultations.
Commonly-occurring outcomes were: question asking, patient participation, patient anxiety, knowledge, satisfaction and consultation length. A minority of studies showed positive effects for these outcomes. Meta-analyses, however, showed small and statistically significant increases for question asking (standardised mean difference (SMD (1) (Storage Module Device) A high-performance hard disk interface used with minis and mainframes that transfers data in the 1-4 MBytes/sec range (SMD-E provides highest rate). See hard disk. ) 0.27 (95% confidence interval confidence interval,
n a statistical device used to determine the range within which an acceptable datum would fall. Confidence intervals are usually expressed in percentages, typically 95% or 99%. (CI) 0.19 to 0.36)) and patient satisfaction (SMD 0.09 (95% CI 0.03 to 0.16)). There was a notable but not statistically significant decrease in patient anxiety before consultations (weighted mean difference (WMD WMD
white muscle disease. ) -1.56 (95% CI -7.10 to 3.97)). There were small and not statistically significant changes in patient anxiety after consultations (reduced) (SMD -0.08 (95%CI -0.22 to 0.06)), patient knowledge (reduced) (SMD -0.34 (95% CI -0.94 to 0.25)), and consultation length (increased) (SMD 0.10 (95% CI -0.05 to 0.25)). Further analyses showed that both coaching and written materials produced similar effects on question asking but that coaching produced a smaller increase in consultation length and a larger increase in patient satisfaction.
Interventions immediately before consultations led to a small and statistically significant increase in consultation length, whereas those implemented some time before the consultation had no effect. Both interventions immediately before the consultation and those some time before it led to small increases in patient satisfaction, but this was only statistically significant for those immediately before the consultation. There appear to be no clear benefits from clinician clinician /cli·ni·cian/ (kli-nish´in) an expert clinical physician and teacher.
n. training in addition to patient interventions, although the evidence is limited.
Interventions before consultations designed to help patients address their information needs within consultations produce limited benefits to patients. Further research could explore whether the quality of questions is increased, whether anxiety before consultations is reduced, the effects on other outcomes and the impact of training and the timing of interventions. More studies need to consider the timing of interventions and possibly the type of training provided to clinicians.