Problems may arise when healthcare providers focus on managing diseases rather than on people and their health problems. Patient-centred approaches to care delivery in the patient encounter are increasingly advocated by consumers and clinicians and incorporated into training for healthcare providers. The authors updated a 2001 systematic review of the effects of these training interventions for healthcare providers that aim to promote patient-centred care in clinical consultations.
They found 29 new randomized trials (up to June 2010), bringing the total of studies included in the review to 43. In most of the studies, training interventions were directed at primary care physicians (general practitioners, internists, paediatricians or family doctors) or nurses practising in community or hospital outpatient settings. Some studies trained specialists. Patients were predominantly adults with general medical problems, though two studies included children with asthma.
These studies showed that training providers to improve their ability to share control with patients about topics and decisions addressed in consultations are largely successful in teaching providers new skills. Short-term training (less than 10 hours) is as successful in this regard as longer training. Results are mixed about whether patients are more satisfied when providers practice these skills. The impact on general health is also mixed, although the limited data that could be pooled showed small positive effects on health status. Patients' specific health behaviours show improvement in the small number of studies where interventions use provider training combined with condition-specific educational materials and/or training for patients, such as teaching question-asking during the consultation or medication-taking after the consultation. However, the number of studies is too small to determine which elements of these multi-faceted studies are essential in helping patients change their healthcare behaviours.

Interventions for providers to promote a patient‐centred approach in clinical consultations

Interventions for providers to promote a patient-centred approach in clinical consultations. A systematic review.

PURPOSE We wanted to identify published randomized trials of interventions to alter the interaction between patients and practitioners, develop taxonomies of the interventions and outcomes, and assess the evidence that such interventions improve patients’ health and well-being.

METHODS Undertaking a systematic review of randomized trials, we sought trials in primary and secondary care with health-related outcomes, which we found by searching MEDLINE, HealthSTAR, and PsycINFO bibliographic databases through 1999. We also completed one round of manual citation searching.

RESULTS Thirty-five trials were included. Most were set in primary care in North America. Trials were heterogeneous in populations, settings, interventions, and measures. Interventions frequently combined several poorly described elements. Explicit theoretical underpinning was rare, and only one study linked intervention through process to outcome measures. Health outcomes were rarely measured objectively (6 of 35), and only 4 trials with health outcomes met predefined quality criteria.

Interventions frequently altered the process of interactions (significantly in 73%, 22 of 30 trials). Principal outcomes favored the intervention group in 74% of trials (26 of 35), reaching statistical significance in 14 (40%). Positive effects on health outcomes achieved statistical significance in 44% of trials (11 of 25); negative effects were uncommon (5 of 25, 20%). Simple approaches to increasing the participation of patients in the clinical encounter, such as providing practitioners with a note from patients about their concerns beforehand, showed promise, as did more complex programs providing specific information about disease and attention to emotion. Apparently similar interventions varied in effectiveness across studies.

CONCLUSIONS Successful interactions between patients and their practitioners lie at the heart of medicine, yet there are few rigorous trials of well-specified interventions to inform best practice. Trial evidence suggests that a range of approaches can achieve changes in this interaction, and some show promise in improving patients’ health. To advance knowledge further, we need to replicate promising studies using rigorous methods. These should include explicit theoretical frameworks designed to link effects on key communication and interaction characteristics through to effects on health outcomes.

https://www.annfammed.org/content/annalsfm/2/6/595.full.pdf

Effect on Health-Related Outcomes of Interventions to Alter the Interaction Between Patients and Practitioners: A Systematic Review of Trials

A meta-analysis of 47 studies investigating the relationship between family-centered helpgiving practices and parent, family, and child behavior and functioning is reported. The studies included more than 11,000 participants from seven different countries. Data analysis was guided by a practice-based theory of family-centered helpgiving that hypothesized direct effects of relational and participatory helpgiving practices on self-efficacy beliefs and parent, family, and child outcomes. Results showed that the largest majority of outcomes were related to helpgiving practices with the strongest influences on outcomes most proximal and contextual to help giver/help receiver exchanges. Findings are placed in the context of a broader-based social systems framework of early childhood intervention and family support.

/pdf/meta-analysis-of-family-centered-helpgiving-practices-37y0pvm0bl.pdf

Meta‐analysis of family‐centered helpgiving practices research

Objective:We sought to synthesize the findings of studies examining interventions to enhance the communication behaviors of physicians and patients during outpatient encounters.Methods:We conducted searches of 6 databases between 1966 and 2005 to identify studies for a systematic review and synthesi

https://www.jstor.org/stable/pdfplus/40221430.pdf

Communication interventions make a difference in conversations between physicians and patients: a systematic review of the evidence.

A brief educational intervention to promote effective communication between physicians, children, and parents during pediatric office visits was designed and tested. A randomized clinical trial involving 141 children (5- to 15-year-olds) tested the effectiveness of the intervention to improve the process and outcome of medical care. The intervention was contained in three brief videotapes (one each for parents, physicians, and patients) and in accompanying written materials. Materials were designed to build skills and motivation for increased child competence and participation during pediatric medical visits. Control subjects saw health education videotapes and received materials comparable in length with those of experimental subjects. Postintervention medical visit process was analyzed using videotapes of visits. Visit outcomes, assessed with standardized instruments and interviews, included children's rapport with physicians, children's anxiety, children's preference for an active health role, children's recall of information, parents' satisfaction with the medical visit, and physician satisfaction. Results indicated that physicians in the intervention group, compared with their counterparts in the control group, more often included children in discussions of medical recommendations (50% vs 29%, t = 2.39, P less than .05); that children in the intervention group, compared with control children, recalled more medication recommendations (77% vs 47%, P less than .01) and reported greater satisfaction and preference for an active health role; and that the intervention and control groups did not differ in parent satisfaction, physician satisfaction, or child anxiety. The results suggest that a brief educational intervention administered during waiting room time can positively impact physician-child rapport and children's preference for an active role in health and their acquisition of medical information.

Increasing patient knowledge, satisfaction, and involvement: randomized trial of a communication intervention

An explicit goal of child health supervision visits is to gather
information and provide guidance about the psychosocial problems of children
and families. The purpose of this study was to determine the extent to which
parents had opportunities to express psychosocial concerns and the nature of
physicians9 responses to these concerns during health supervision visits. The
authors analyzed videotapes of child health supervision visits by 34 children
aged 5-12 years to 34 pediatric and family medicine residents. Coding systems
with acceptable interobserver reliability were developed to assess (1) the
nature of opportunities provided to express concerns, (2) categories of
psychosocial problems expressed by parents and children, and (3) the nature of
physicians9 responses. In 88% of the child health supervision visits,
opportunities were created by the physician to discuss psychosocial concerns
or were spontaneously raised by the parent or child. In half of the visits,
parents or children expressed a total of 30 psychosocial concerns.
Psychosocial problems raised included conduct/behavior problems (47%),
insecurity (13%), family, sibling, or social problems (13%), learning
difficulties (10%), somatization (7%), and other (10%). Physicians9 responses
to these psychosocial concerns were as follows: 17% ignored the concern; 43%
asked further exploratory questions but provided no information, reassurance,
or guidance; 3% reassured the parent; 27% responded with psychosocial
information and/or action; 3% responded with medical information and/or
action; and 7% responded with a combination of these latter two modes of
actions. Pediatric residents were more likely to respond to more disruptive
behavioral concerns (r = .60, P < .05). This study has
documented that parents and children are given and take the opportunity to
express psychosocial concerns to their physicians. Unfortunately, in only 40%
of cases did physicians respond with information, reassurance, guidance, or
referral. This study suggests the importance of further efforts focusing on
the ability of physicians to respond effectively to patients9 psychosocial
concerns.

Lee Sharp

Papers

Increasing patient knowledge, satisfaction, and involvement: randomized trial of a communication intervention

Psychosocial problems during child health supervision visits: eliciting, then what?