The views of New Zealand general practitioners and patients on a proposed risk assessment and communication tool: a qualitative study using Normalisation Process Theory

Abstract

Background Communicating risks of medication harm and obtaining informed consent is difficult due to structural barriers, language and cultural practices, bias and a lack of resources appropriately tailored for the health literacy of most patients. A decision support tool was proposed to alert prescribers of risk and provide tailored information for patients to facilitate informed decision-making with patients and their whānau (family) around medication use. Patient and prescriber co-design was used to ensure the tool was designed to best meet the needs of end-users and avoid increasing health inequity. This paper describes the first stage of the co-design process. Method Normalisation Process Theory (NPT) was used to prospectively evaluate the tool. Semi-structured interviews were held with fifteen patients (five Māori, five Pasifika and five NZ European) and nine general practitioners (two Māori and seven European). Results Three themes were identified, which related to the three NPT concepts most relevant to developing the tool. Theme 1 (coherence: meaning and sense making by participants) explored participants’ understanding of prescribing safety, medication harm and risk, which is based on experience. Patients want as much information as possible about their medications and risk, but doctors find it difficult to communicate that information. Theme 2 related to the NPT concept of cognitive participation (commitment and engagement by participants) explored what participants thought about a prescribing decision support tool. Participants were cautiously optimistic, but worried about potential harm arising from its use. They also identified requirements for the tool and features to avoid. Theme 3 describes the collective action required for successful implementation of the tool; namely, culturally safe and trustworthy doctor-patient relationships. Conclusion Patients and general practitioners provided different perspectives when prospectively evaluating the proposed risk assessment and communication tool. This co-design research identified important pre-requisites for the tool and features to avoid and novel ideas for the proposed tool. Overall participants supported the development of the proposed risk assessment and communication tool, but identified the important role that doctor-patient relationships would play to ensure successful implementation. The use of Māori and Pacific languages in the proposed tool may enhance engagement and understanding.

Using an Information Package to Reduce Patients’ Risk of Renal Damage: Protocol for a Randomized Feasibility Trial

“…Most patients consider doctors to be their main source of health information. Patients want to be able to share that information with their whanau (family) as well as health professionals [ 12 , 13 ], but doctors do not always provide patients with that information [ 14 , 15 ]. Doctors find communicating risk information difficult [ 16 , 17 ], and communicating potential risks of NSAIDs may be incomplete [ 18 ].…”

“…Doctors find communicating risk information difficult [ 16 , 17 ], and communicating potential risks of NSAIDs may be incomplete [ 18 ]. Time, low health literacy levels, and lack of patient interest have been suggested as additional barriers to communication [ 13 ].…”

“…Most medication information for patients is in leaflet form, with patient information resources becoming increasingly available online. Patients search for high-quality, reputable information, but find it hard to judge the quality of the information they find online [ 13 ]. A few studies have examined novel modalities of delivering health information to patients, but there is room for further research to evaluate the efficacy of alternative media modalities [ 25 , 26 ].…”

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“…Communication is key to empowerment and autonomy. 9,29 As participants suggested, both positive and negative communication experiences will have long-term impacts regarding (not) trusting health providers and (not) seeking timely health care. 5,[30][31][32][33][34] Critically, trust is also based on the experiences of whānau and others within communities.…”