A questionnaire study of GPs’ and patients’ beliefs about the different components of patient centredness

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Abstract

Much research has explored the interaction between doctor and patient in the consultation and patient centredness has generally emerged as the preferred mode of consultation style. The present study aimed to examine and compare general practitioners’ (GPs) and patients’ beliefs about the importance of the different aspects of patient centred behaviour in a consultation. Matched questionnaires were completed by 410 patients (response rate=76.5%) and 64 GPs (response rate=85.3%) from practices around London concerning aspects of patient centredness operationalised in terms of doctor receptiveness, patient involvement, the affective content of the relationship and information giving. The results showed that GPs and patients showed similar beliefs about involving the patient in decision making, aspects of doctor receptiveness and the importance of the patient’s own feelings in the consultation. However, GPs believed that it was less important to focus only on the patient’s main problem, and more important to acknowledge their own feelings and avoid medical language. Further, GPs rated doctor receptiveness and the affective content of the relationship overall as more important for a good consultation than the patients. The patients also consistently rated information giving as more important than the GPs. To conclude, GPs rated the doctor receptiveness and affective components of patient centredness as more important than patients whereas patients showed greater endorsement of information indicating that although patient centredness may currently be the preferred style of consultation, doctors and patients prefer different aspects of this behaviour.

Introduction

First developed by Byrne and Long in 1976 [1] the concept of patient centredness has become increasingly in vogue over recent years. The prescriptive literature has recommended patient centredness as the preferred style of doctor–patient communication as a means to improve patient outcomes [2], [3], [4]. Further, empirical research has explored both the extent to which consultations can be deemed to be patient centred [1], [2], [3], [4], [5], [6], [7] and whether patient centredness is predictive of outcomes such as patient satisfaction, compliance and patient health status [8], [9], [10], [11]. Such research has raised questions concerning both the definition of patient centredness and its assessment which has resulted in a range of methodological approaches. For example, some studies have used coding frames such as the Stiles verbal response mode system [12] or the Roter index [13] as a means to code whether a particular doctor is behaving in a patient centred fashion [14], [15]. In contrast, other studies have used interviews with patients and doctors [9] whilst some have used behavioural checklists [1]. Complicating the matter further, research studies exploring the doctor–patient interaction and the literature proposing a particular form of interaction have used a wide range of different but related terms such as shared decision making [16], [17], patient participation [18] and patient partnership [19]. However, although varying in their operationalisation of patient centredness, in general the construct is considered to consist of three central components; namely, (i) a receptiveness by the doctor to the patient’s opinions and expectations and an effort to see the illness through the patient’s eyes; (ii) patient involvement in the decision making and planning of treatment and (iii) an attention to the affective content of the consultation in terms of the emotions of both the patient and the doctor. This framework is reflected in the MRCGP assessment criteria for general practitioners (GPs) with questions relating to eliciting the patients perspective, involving the patient in treatment plans and establishing rapport [20]. In addition, it is comparable to the six interactive components described by Levenstein and co-workers [7] and is apparent in the five key dimensions described by Mead and Bower [21] in their comprehensive review of the patient centred literature. Finally, it is explicitly described by Winefield and colleagues in their work comparing the effectiveness of different measures [14]. At times, research suggests that patient centredness also includes ‘information giving’ and several scales include measures of this component of consultation behaviour [22], [23], [24]. However, there is less consensus regarding this construct as it is not apparent in all measures [25], [26] and is similar to ‘giving directions’ which was central to Byrne and Long’s concept of doctor centredness.

Therefore, patient centredness is currently regarded as the preferred mode of doctor–patient communication. With its focus on the patient’s perspective this approach is in line with the shift towards seeing the patient as a consumer of health care and the patients’ charter [27]. It is also in line with statements in the medical press such as ‘patient partnership is therefore firmly on the agenda in the NHS’ [19] and reflects recent UK government strategies for healthier citizens [28]. However, although patient centredness as an approach emphasises patient preferences in terms of treatment and management, to date it has only been assumed that patients prefer a patient centred consultation style. Further, although patient centredness emphasises the need for agreement between patients and their doctors, no research has examined the extent to which they agree about the value of patient centredness itself. Therefore, the present study aimed to explore patients’ and GPs’ beliefs about their preferred consultation style and specifically to examine the extent to which they agreed or differed in their beliefs about the different components considered to constitute patient centredness.

Section snippets

Participants

As part of the London Academic Training Scheme (LATS) for GPs, six LATS students distributed 533 questionnaires to consecutive patients aged over 16 in six general practices across London. Patients were excluded if they were deemed incapable of completing the questionnaire due to sight or mental health problems. Matched questionnaires were also given to 75 GPs from these and neighbouring practices. Completed questionnaires were received from 408 patients (response rate=76.5%) and 64 GPs

Results

The results were first analysed to describe the participants’ profile characteristics. They were then analysed to compare GPs’ and patients’ beliefs about the consultation in terms of both the individual items and summated items reflecting the four dimensions of patient centredness. Levene’s test of homogeneity of variance was carried out and the data was analysed using X2 and t-tests.

Discussion

The present study aimed to examine and compare GPs’ and patients’ beliefs about the importance of the different components of patient centredness in a consultation. However, there are some problems with the methodology which need to be considered. Firstly, the sample was not recruited from a random selection of practices. The response rates, however, were high and the profile characteristics of both the GPs and patients suggest that the participants in this study are comparable to GPs and

Acknowledgements

The project was completed as part of the Research Methods component for LATS for GPs supervised by JO.

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