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Meta-Analysis
. 2008 Jul 16:337:a485.
doi: 10.1136/bmj.a485.

Interventions before consultations to help patients address their information needs by encouraging question asking: systematic review

Paul Kinnersley  1 , Adrian Edwards, Kerry Hood, Rebecca Ryan, Hayley Prout, Naomi Cadbury, Fergus MacBeth, Phyllis Butow, Christopher Butler
Affiliations
Meta-Analysis

Interventions before consultations to help patients address their information needs by encouraging question asking: systematic review

Paul Kinnersley et al. BMJ. .

Abstract

Objective: To assess the effects on patients, clinicians, and the healthcare system of interventions before consultations to help patients or their representatives gather information in consultations by question asking.

Design: Systematic review with meta-analysis.

Data sources: Electronic literature searches of seven databases and hand searching of one journal and bibliographies of relevant articles. Review methods Inclusion criteria included randomised controlled trials.

Main outcome measures: Primary outcomes were question asking; patients' anxiety, knowledge, and satisfaction; and length of consultation.

Results: 33 randomised trials of variable quality involving 8244 patients were identified. A few studies showed positive effects. Meta-analyses showed small and statistically significantly increases in question asking (standardised mean difference 0.27, 95% confidence interval 0.19 to 0.36) and patients' satisfaction (0.09, 0.03 to 0.16). Non-statistically significant changes occurred in patients' anxiety before consultations (weighted mean difference -1.56, -7.10 to 3.97), patients' anxiety after consultations (standardised mean difference -0.08, -0.22 to 0.06), patients' knowledge (-0.34, -0.94 to 0.25), and length of consultation (0.10, -0.05 to 0.25). Interventions comprising written materials had similar effects on question asking, consultation length, and patients' satisfaction as those comprising the coaching of patients. Interventions with additional training of clinicians had little further effect than those targeted at patients alone for patients' satisfaction and consultation length.

Conclusions: Interventions for patients before consultations produce small benefits for patients. This may be because patients and clinicians have established behaviours in consultations that are difficult to change. Alternatively small increases in question asking may not be sufficient to make notable changes to other outcomes.

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Conflict of interest statement

Competing interests: PK directs a university unit that generates income by delivering training in communication skills to clinicians.

Figures

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Fig 1 Flow of papers
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Fig 2 Effect of interventions before consultation to encourage patients to ask questions
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Fig 3 Effect on patients’ anxiety before consultations of interventions to encourage patients to ask questions in consultations
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Fig 4 Effect on patients’ anxiety after consultations of interventions to encourage patients to ask question in consultations
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Fig 5 Effect on patients’ knowledge of interventions to encourage patients to ask questions in consultations
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Fig 6 Effect on patients’ satisfaction of interventions to encourage patients to ask questions in consultations
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Fig 7 Effect on consultation length of interventions to encourage patients to ask questions in consultations
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References

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