Findings from a feasibility study to improve GP elicitation of patient concerns in UK general practice consultations

Leydon, Geraldine; Stuart, Beth; Summers, Rachael; Little, Paul; Ekberg, Stuart; Stevenson, Fiona; Chew‐Graham, Carolyn; Brindle, Lucy; Drew, Paul; Moore, Michael

doi:10.1016/j.pec.2018.03.009

Cited by 14 publications

(5 citation statements)

References 15 publications

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“…The current results concur with past research, which found that when patients are free to express themselves, they are likely to initiate between 2–3 concerns [ 26 , 27 ]. This is consistent with the current study where non-PCI patients raised on average 2.9 concerns.…”

Section: Discussionsupporting

confidence: 92%

“…This finding was not in the expected direction, where it was predicted that consultants in the PCI group would refer to the concerns highlighted by the patient (raised when completing the PCI) and initiate the first concern accordingly. However, literature suggests that consultants will begin with an open question such as “How can I help you today?” [ 27 ], where patients will reply with the initiation of the first concern [ 32 ]. Our results show this to be consistent regardless of the PCI being used to highlight concerns pre-consultation.…”

Section: Discussionmentioning

confidence: 99%

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Concerns raised by people treated for head and neck cancer: a secondary analysis of audiotaped consultations in a health services follow-up clinic

Dicks,

Rogers,

Kanatas

et al. 2023

Support Care Cancer

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Purpose People treated for head and neck cancer (HNC) face various barriers in communicating concerns with consultants. Our aim was to investigate the number of concerns raised between patients using the Patient Concerns Inventory (PCI) and those who did not. The PCI is a 57-item prompt list used in routine HNC follow-up clinics. Additionally, we aimed to examine whether who initiated the concerns differed between groups and the factors that may predict this initiation. Methods Secondary data analysis included 67 participants across 15 HNC consultants from specialist cancer centres in Liverpool and Leeds. Seven consultants utilised the PCI and eight did not, assigned by preferential and random assignment. Results Patients in the PCI group raised on average 2.5 more concerns than patients in the non-PCI group (p < .001). There was no significant relationship between group and who initiated the first concern (p = .28). A mixed-effects logistic regression was found to significantly predict who initiated the first concern in consultations (p < .05). Discussion The number of concerns raised by patients increased when the PCI was introduced pre-HNC consultation. A number of factors were shown to predict the number of concerns raised in consultations by both patient and consultant. As concerns may not be raised further following the concern mentioned, we propose that the discussion of concerns needs to be maintained by the clinician throughout the consultation and not solely at the start. Conclusion The PCI promoted the sharing of concerns in follow-up consultations between patient and consultant.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Concerns raised by people treated for head and neck cancer: a secondary analysis of audiotaped consultations in a health services follow-up clinic

Dicks,

Rogers,

Kanatas

et al. 2023

Support Care Cancer

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“…Additional concerns are medical problems (Byrne and Long, 1976) that are prima facie unrelated to the main reason for the visit. Consequently, interventions have been developed to help physicians better solicit additional concerns from patients (Heritage and Robinson, 2011;Robinson et al, 2016;Leydon et al, 2018;Stuart et al, 2018). What has not yet been studied is when and how physicians initiate additional concerns and what functions they serve.…”

Section: Introductionmentioning

confidence: 99%

When and how do surgeons initiate noticings of additional concerns?

White

2020

Social Science & Medicine

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Physicians are trained on how to best solicit additional concerns from patients. What has not yet been studied is when and how physicians initiate additional concerns. This analysis focuses on when and how general surgeons share their noticings of medical problems unrelated to the upcoming (or recent) procedures that patients are being seen for. Methods: 281 video-recorded medical encounters with 95 patients from a rural Texas (USA) general surgery private practice were reviewed for surgeon noticings of additional concerns. In addition to analyzing the videos using Conversation Analysis, the author conducted 9 months of ethnographic research to gain understanding of the local setting. Results: 22 cases of surgeon noticings were found in 17 visits and were typically detected during the physical examination. Surgeons shared noticings adjacent to their discovery and predominantly framed noticings as bad news tellings. This framing helped mitigate 4 dilemmas surgeons encountered: unknown patient awareness of concern, surgeons' rights to assess areas unrelated to upcoming (or recent) procedures, not meeting the desired health optimization outcome & putting additional burden on patients, and other contextual factors specific to the visit that make sharing a noticing difficult. In addition to alerting patients and potentially activating earlier treatment, sharing noticings can also function to help build physician-patient relationships across time and curtail future patient worry. Implications: Each surgeon noticing is potentially a concern that may have otherwise remained undetected and untreated, and speaks to the importance of physicians taking time to conduct thorough physical examinations.

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“…Evidence suggests that missed diagnoses10 11 are often related to inadequate symptom elicitation12 and doctors’ elicitation and interpretation of the presenting problem is critical for subsequent referral decisions 13 14. However, elicitation can often be incomplete,15 16 and if doctors do not ask for information, patients often do not provide it 17 18. Despite a vast existing body of research exploring the conversation between patients and doctors,19 which is embedded within doctor communication training (eg, the Calgary-Cambridge model),20 there is a lack of in-depth research on doctor-patient interactions to elucidate the essential behavioural factors central to this diagnostic phase.…”

Section: Introductionmentioning

confidence: 99%

Influence of doctor-patient conversations on behaviours of patients presenting to primary care with new or persistent symptoms: a video observation study

et al. 2019

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BackgroundMost cancers are diagnosed following contact with primary care. Patients diagnosed with cancer often see their doctor multiple times with potentially relevant symptoms before being referred to see a specialist, suggesting missed opportunities during doctor-patient conversations.ObjectiveTo understand doctor-patient communication around the significance of persistent or new presenting problems and its potential impact on timely cancer diagnosis.Research designQualitative thematic analysis based on video recordings of doctor-patient consultations in primary care and follow-up interviews with patients and doctors. 80 video observations, 20 patient interviews and 7 doctor interviews across 7 general practices in England.ResultsWe found that timeliness of diagnosis may be adversely affected if doctors and patients do not come to an agreement about the presenting problem’s significance. ‘Disagreements’ may involve misaligned cognitive factors such as differences in medical knowledge between doctor and patient or misaligned emotional factors such as patients’ unexpressed fear of diagnostic procedures. Interviews suggested that conversations where the difference in views is either not recognised or stays unresolved may lead to unhelpful patient behaviour after the consultation (eg, non-attendance at specialist appointments), creating potential for diagnostic delay and patient harm.ConclusionsOur findings highlight how doctor-patient consultations can impact timely diagnosis when patients present with persistent or new problems. Misalignments were common and could go unnoticed, leaving gaps for potential to cause patient harm. These findings have implications for timely diagnosis of cancer and other serious disease because they highlight the complexity and fluidity of the consultation and the subsequent impact on the diagnostic process.

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Findings from a feasibility study to improve GP elicitation of patient concerns in UK general practice consultations

Abstract: GPs can solicit early for additional concerns and GPs can establish patients' additional concerns in the opening of the consultation, which can help to plan and prioritise patients multiple concerns.

Cited by 14 publications

References 15 publications

Concerns raised by people treated for head and neck cancer: a secondary analysis of audiotaped consultations in a health services follow-up clinic

Concerns raised by people treated for head and neck cancer: a secondary analysis of audiotaped consultations in a health services follow-up clinic

When and how do surgeons initiate noticings of additional concerns?

Influence of doctor-patient conversations on behaviours of patients presenting to primary care with new or persistent symptoms: a video observation study

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