Socio‐economic differences in patient participation behaviours in doctor–patient interactions—A systematic mapping review of the literature

Allen, Sarah; Rogers, Simon; Harris, Rebecca

doi:10.1111/hex.12956

Cited by 15 publications

(11 citation statements)

References 62 publications

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“…It examines the influence of socio-economic inequalities, drawing from the Commission on Social Determinants of Health (CSDH), a global network brought together by the WHO that aims to address the social causes of poor health and health inequity by inspiring policy and institutional change ( 23 ). The CSDH framework shows how socio-economic and political mechanisms such as income, housing, education, and employment gives rise to economically stratified populations, which in turn, shapes health determinant status and differences in vulnerability to morbid conditions ( 24 , 25 ). These factors play a role in shaping the lives of older people and can determine the extent to which the complexities of multi-morbidity are managed ( 25 ).…”

Section: Introductionmentioning

confidence: 99%

“…The CSDH framework shows how socio-economic and political mechanisms such as income, housing, education, and employment gives rise to economically stratified populations, which in turn, shapes health determinant status and differences in vulnerability to morbid conditions ( 24 , 25 ). These factors play a role in shaping the lives of older people and can determine the extent to which the complexities of multi-morbidity are managed ( 25 ). The study proposes implementing redistributive welfare policies or social program that reallocate wealth to citizens in order to reduce socioeconomic inequalities.…”

Section: Introductionmentioning

confidence: 99%

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Multi-Morbidity in the Older Person: An Examination of Polypharmacy and Socioeconomic Status

Nwadiugwu

2021

Front. Public Health

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There has been increased focus on clinically managing multi-morbidity in the older population, but it can be challenging to find appropriate paradigm that addresses the socio-economic burden and risk for polypharmacy. The Commission on Social Determinants of Health (CSDH) has examined the need for institutional change and the parallel need to address the social causes of poor health. This study explored three potential interventions namely, meaningful information from electronic health records (EHR), social prescribing, and redistributive welfare policies from a person-centered perspective using the CARE (connecting, assessing, responding, and empowering) approach. Economic instruments that immediately redistribute state welfare and reduce income disparity such as direct taxation and conditional cash transfers could be adopted to enable older people with long-term conditions have access to healthcare services. Decreased socioeconomic inequality and unorthodox prescriptive interventions that reduce polypharmacy could mitigate barriers to effectively manage the complexities of multi-morbidity.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Multi-Morbidity in the Older Person: An Examination of Polypharmacy and Socioeconomic Status

Nwadiugwu

2021

Front. Public Health

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“…However, there has been a lack of research to explain these socioeconomic differences. Furthermore, the impact of SES on the effectiveness of the doctor‐patient relationship and communication in head and neck cancer has not been well studied 15 . Malignancies of the head and neck are the 8th most common cancer in the United Kingdom; approximately 4000 die annually from the disease 16 .…”

Section: Introductionmentioning

confidence: 99%

What are the underlying reasons behind socioeconomic differences in doctor‐patient communication in head and neck oncology review clinics?

Allen

Rogers

Brown³

et al. 2020

Health Expectations

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Objective To explore socioeconomic status (SES) differences in patterns of doctor‐patient communication within head and neck cancer clinics and why such differences exist. Methods Thirty‐six head and neck cancer review appointments with five Physicians were observed and audio‐taped, along with follow‐up interviews involving 32 patients. Data were analysed using Thematic Analysis, and compared by patient SES (education, occupation and Indices of Multiple Deprivation). Results Three main themes were identified: (a) Physicians used more humour and small talk in their consultations with high SES patients; (b) Low SES patients were more passive in their participation, engaged in less agenda setting and information‐seeking, and framed their clinical experience differently; (c) Low SES patients had different preferences for involvement, defining involvement differently to high SES patients and were seen to take a more stoical approach. Conclusion Low SES patients take a more passive role in medical consultations, engage in less relational talk and are less likely to raise concerns, but were satisfied with this. Physicians may adapt their communication behaviour in response to low SES patients’ expectations and preferences. Practice Implications A question prompt list may help low SES patients to raise concerns during their consultations. This may reduce inequalities in communication and health.

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“…It remains to be fully evaluated but the hypothesis is that the prompt allows the patient permission to talk about this aspect and seek reassurance or further information. The PCI approach might be very helpful for those HNC patients likely to take a more passive role in medical consultations, such as patients of lower socio-economic strata [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Improving quality of life through the routine use of the patient concerns inventory for head and neck cancer patients: main results of a cluster preference randomised controlled trial

Rogers

Allmark

Bekiroglu

et al. 2020

Eur Arch Otorhinolaryngol

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Purpose The patient concerns inventory (PCI) is a prompt list allowing head and neck cancer (HNC) patients to discuss issues that otherwise might be overlooked. This trial evaluated the effectiveness of using the PCI at routine outpatient clinics for one year after treatment on health-related QOL (HRQOL). Methods A pragmatic cluster preference randomised control trial with 15 consultants, 8 ‘using’ and 7 ‘not using’ the PCI intervention. Patients treated with curative intent (all sites, disease stages, treatments) were eligible. Results Consultants saw a median (inter-quartile range) 16 (13–26) patients, with 140 PCI and 148 control patients. Of the pre-specified outcomes, the 12-month results for the mean University of Washington Quality of Life (UW-QOLv4) social-emotional subscale score suggested a small clinical effect of intervention of 4.6 units (95% CI 0.2, 9.0), p = 0.04 after full adjustment for pre-stated case-mix. Results for UW-QOLv4 overall quality of life being less than good at 12 months (primary outcome) also favoured the PCI with a risk ratio of 0.83 (95% CI 0.66, 1.06) and absolute risk 4.8% (− 2.9%, 12.9%) but without achieving statistical significance. Other non-a-priori analyses, including all 12 UWQOL domains and at consultant level also suggested better HRQOL with PCI. Consultation times were unaffected and the number of items selected decreased over time. Conclusion This novel trial supports the integration of the PCI approach into routine consultations as a simple low-cost means of benefiting HNC patients. It adds to a growing body of evidence supporting the use of patient prompt lists more generally.

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Socio‐economic differences in patient participation behaviours in doctor–patient interactions—A systematic mapping review of the literature

Cited by 15 publications

References 62 publications

Multi-Morbidity in the Older Person: An Examination of Polypharmacy and Socioeconomic Status

Multi-Morbidity in the Older Person: An Examination of Polypharmacy and Socioeconomic Status

What are the underlying reasons behind socioeconomic differences in doctor‐patient communication in head and neck oncology review clinics?

Improving quality of life through the routine use of the patient concerns inventory for head and neck cancer patients: main results of a cluster preference randomised controlled trial

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