2008 - 2011
The Norwegian Research Council
Patients are the experts on their own symptoms, concerns, and what matters most to them and it is important that they share this information with their clinician. Consultations are often restricted in time due to clinicians’ busy schedules, meaning that the essence of the patients’ problems must be found rather quickly. This poses an extra challenge to the communication process. This calls for an intervention that can be integrated into the daily routine of a busy clinical environment and can also be tailored to each individual patient. Recently, interactive tailored patient assessment (ITPA) instruments have increasingly emerged in different health care settings. We know from previous literature that the use of ITPAs has positive impact on several patient outcomes. However, we do not know what effect ITPAs have on the actual communication between clinicians and patients. One example of an ITPA is Choice (Creating better Health Outcomes by Improving Communication about patients` Experiences), administered to patients on a tablet computer with a touch sensitive screen.
The overall aim of this research project was to test the effect of the Choice ITPA on patient-clinician communication. More specifically, the study aimed to test the effects of the Choice ITPA on:
- Number and types of symptoms addressed during consultations
- The information given by clinicians during the consultations
- The content of the consultations
- Patients’ participation during consultations
- Clinicians’ communication styles in the consultations
- The communication patterns in the consultations
- The differences or similarities of the physicians’ and nurses’ communication in the consultations
This study was a controlled two-group clinical trial with a quasi-experimental design. A convenience sample of 196 patients with leukemia, lymphoma, multiple myeloma, sarcoma, or testicular cancer from two hospital wards and two outpatient clinics constitutes the total study sample of the project. Five physicians and 16 nurses consented to participate. Consultations were audio taped and coded using both the Verona Coding Definitions of Emotional Sequencesand Roter Interaction Analysis System.
Several of the findings indicated that the Choice ITPA have an effect on both patients’ and clinicians’ communicative behavior. Firstly, more symptoms were discussed in the intervention group consultations compared to in the standard consultations. Particularly, more symptoms related to pain and psychosocial issues were discussed. Secondly, patients were more active participants in consultations in the Choice intervention group. This was evident in two ways; patients asked more questions to the clinicians in the Choice intervention group, and the questions were more specific, and patients expressed more cues to negative emotions and emotional concerns, and these cues and concerns were also more explicit. Clinicians did not change their response types, but they did provide patients with more information when the Choice ITPA was used. Finally, cancer patients’ expressions of cues and concerns did not occur at random. More cues and concerns were expressed early in the consultation, in consultations with nurses, and in the Choice intervention group. Cues and concerns that were initiated by the clinician were more likely to occur in the first ten minutes of the consultations, and the first cue or concern expressed were more likely to be more explicit than those expressed later in the consultation.
- Heyn L, Ruland CM, Finset A (2011). Effects of an interactive tailored patient assessment tool on eliciting and responding to cancer patients' cues and concerns in clinical consultations with physicians and nurses. Patient Educ Couns. 2011 May 16. doi:10.1016/j.pec.2011.04.024.
- Heyn L, Finset A, Eide H, Ruland CM (2011). Effects of an interactive tailored patient assessment on patient-clinician communication in cancer care.Psychooncology. 2011 Sep 15. doi: 10.1002/pon.2064
- Patterns in clinicians' responses to patient emotion in cancer care. Patient Educ Couns, 93 (1), 80-5
- (2013). , , Talking about feelings and worries in cancer consultations: the effects of an interactive tailored symptom assessment on source, explicitness, and timing of emotional cues and concerns. Cancer Nurs, 36 (2), E20-30