Patients with worry: presentation of concerns and expectations for response

Floyd, Michael; Lang, Forrest; McCord, Ronald; Keener, Melinda

doi:10.1016/j.pec.2004.06.002

Cited by 25 publications

(16 citation statements)

References 15 publications

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“…This may be challenging considering that training in medical communication skills tends to be of a quite generic nature [37]. It might be particularly challenging to address patients’ undisclosed or ambiguously expressed concerns, a phenomenon present in this study as well as in previous research [38]. …”

Section: Discussionmentioning

confidence: 83%

“Doctor, please tell me it’s nothing serious”: an exploration of patients’ worrying and reassuring cognitions using stimulated recall interviews

et al. 2014

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BackgroundMany patients who consult their GP are worried about their health, but there is little empirical data on strategies for effective reassurance. To gain a better understanding of mechanisms for effective patient reassurance, we explored cognitions underlying patients’ worries, cognitions underlying reassurance and factors supporting patients’ reassuring cognitions.MethodsIn a qualitative study, we conducted stimulated recall interviews with 21 patients of 12 different GPs shortly after their consultation. We selected consultations in which the GPs aimed to reassure worried patients and used their videotaped consultation as a stimulus for the interview. The interviews were analysed with thematic coding and by writing interpretive summaries.ResultsPatients expressed four different core cognitions underlying their concerns: ‘I have a serious illness’, ‘my health problem will have adverse physical effects’, ‘my treatment will have adverse effects’ and ‘my health problem will negatively impact my life’. Patients mentioned a range of person-specific and context-specific cognitions as reasons for these core cognitions. Patients described five core reassuring cognitions: ‘I trust my doctor’s expertise’, ‘I have a trusting and supporting relationship with my doctor’, ‘I do not have a serious disease’, ‘my health problem is harmless’ and ‘my health problem will disappear.’ Factors expressed as reasons for these reassuring cognitions were GPs’ actions during the consultation as well as patients’ pre-existing cognitions about their GP, the doctor-patient relationship and previous events. Patients’ worrying cognitions were counterbalanced by specific reassuring cognitions, i.e. worrying and reassuring cognitions seemed to be interrelated.ConclusionsPatients described a wide range of worrying cognitions, some of which were not expressed during the consultation. Gaining a thorough understanding of the specific cognitions and tailoring reassuring strategies to them should be an effective way of achieving reassurance. The identified reassuring cognitions can guide doctors in applying these strategies in their daily practice.

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Section: Discussionmentioning

confidence: 83%

“Doctor, please tell me it’s nothing serious”: an exploration of patients’ worrying and reassuring cognitions using stimulated recall interviews

et al. 2014

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“…[23][24][25] Participants viewed videos of 3 types of physician inquiry and then rated the inquiries based on their personal preference and perception of effectiveness.…”

Section: Methodsmentioning

confidence: 99%

Patients Prefer the Method of "Tell Back- Collaborative Inquiry" to Assess Understanding of Medical Information

Kemp¹,

Floyd²,

McCord-Duncan³

et al. 2008

The Journal of the American Board of Family Medicine

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Purpose: The goal of this study was to determine which approach to assessing understanding of medical information patients most prefer and perceive to be most effective.Methods: Two videos were shown to participants: (1) a physician explaining a medical condition and its treatment and (2) a physician inquiring about patient understanding of the medical information the patient had been given using There is considerable evidence that many patients leave medical encounters with a poor understanding of their disease and the recommended treatment. Hewson 1 found that, when patients were asked to explain what had been told them, their explanations included so many gaps and errors that half of the information they had been given was lost. Several early studies substantiated poor understanding of medical information, with reports of lost information ranging from 46% to 63%. 2-7More recently, a study of 20 general practices in England reported that misunderstandings associated with actual or potential adverse outcomes occurred in 80% of consultations.8 A study of patient retention of information given during consent for mammoplasty found that patients were able to recollect on average 3 of 12 pieces of the information given them, or only 25%. 9 In another study, patients were asked immediately after discharge from the emergency department about diagnosis and treatment recommendations; although 79% of patients gave the correct diagnosis, correct treatment information was given by only 49% of patients.

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“…Not all patients who choose to share their worries with their physicians do so directly. Rather, many patients, including those with multiple unexplained symptoms, 4 cue their physicians to their concerns by telling stories, amplifying their concerns, 2,13,16 or using affectively "loaded questions". Loaded questions are often superficially straightforward, but reflect underlying feelings of fear, anger, or apprehension that should be addressed.…”

Section: Introductionmentioning

confidence: 99%

“Could this Be Something Serious?”

et al. 2007

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BACKGROUND: Previous work suggests that exploration and validation of patients' concerns is associated with greater patient trust, lower health care costs, improved counseling, and more guideline-concordant care. OBJECTIVE:To describe physicians' responses to patients' worries, how their responses varied according to clinical context (straightforward versus medically unexplained symptoms [MUS]) and associations between their responses and patients' ratings of interpersonal aspects of care.DESIGN: Multimethod study. For each physician, we surveyed 50 current patients and covertly audiorecorded 2 unannounced standardized patient (SP) visits. SPs expressed worry about "something serious" in 2 scenarios: straightforward gastroesophageal reflux or poorly characterized chest pain with MUS. PARTICIPANTS:One hundred primary care physicians and 4,746 patients. MEASUREMENTS:Patient surveys measuring interpersonal aspects of care (trust, physician knowledge of the patient, satisfaction, and patient activation). Qualitative coding of 189 transcripts followed by descriptive, multivariate, and lag-sequential analyses. RESULTS:Physicians offered a mean of 3.1 responses to each of 613 SP prompts. Biomedical inquiry and explanations, action, nonspecific acknowledgment, and reassurance were common, whereas empathy, expressions of uncertainty, and exploration of psychosocial factors and emotions were uncommon. Empathy expressed during SP visits was associated with higher patient ratings of interpersonal aspects of care. After adjusting for demographics and comorbidities, the association was only statistically significant for the MUS role. Empathy was most likely to occur if expressed at the beginning of the conversational sequence.CONCLUSIONS: Empathy is associated with higher patient ratings of interpersonal care, especially when expressed in situations involving ambiguity. Empathy should be expressed early after patient expressions of worry.

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Patients with worry: presentation of concerns and expectations for response

Cited by 25 publications

References 15 publications

“Doctor, please tell me it’s nothing serious”: an exploration of patients’ worrying and reassuring cognitions using stimulated recall interviews

“Doctor, please tell me it’s nothing serious”: an exploration of patients’ worrying and reassuring cognitions using stimulated recall interviews

Patients Prefer the Method of "Tell Back- Collaborative Inquiry" to Assess Understanding of Medical Information

“Could this Be Something Serious?”

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