- Doctors need to determine a way by which they can incorporate goal-setting conversations into primary care as a way to boost shared patient decision-making, shows a study recently published in the Annals of Family Medicine.
The study took two groups of patients and either administered a questionnaire asking about their health-related goals and their quality of life goals, or simply asked about their symptoms. Patients were randomly assigned to their doctors, and the doctors reviewed the questionnaires prior to the care encounter.
Based off of prior industry research, the researchers hypothesized that providers’ encounters with patients who filled out a goal-setting questionnaire will center more on patient wellness and shared decision-making.
“We wondered if patients could encourage their primary care physicians to use a more direct, patient-centered approach to care by using routine pre-encounter forms to alert their physicians to the activities important to them,” the research team, led by Becky Purkaple, stated.
“Interventions that include activation of clinicians by pre-consultation questionnaires have been shown to significantly influence the patient-physician encounter and promote positive outcomes.”
However,the study found that this was not the case.
In intervention encounters, only one patient mentioned quality of life, and even then it was not mentioned in the context of shared decision-making. This may have been because patients are uncomfortable with or unable to begin conversations about their quality of life with their physicians, and instead need physician direction to do so.
“This could have been because patients prefer that their physicians open the [quality of life] discussion or because there was no logical place to bring up meaningful life activities within the standard medical encounter,” the research team explained.
“In addition to completing a pre-visit questionnaire, patients may need training and possibly even pre-visit coaching in order to be able to adopt this new behavior.”
Likewise, only one provider mentioned quality of life, and that was only in the context of the patient’s glycemic index, and not used to inform shared decision-making.
One potential explanation for this is that the physicians were not carefully reviewing the pre-visit questionnaires. Not all of the physicians showed keen interest in the forms, but they did explain to their patients the importance of reviewing and completing the questionnaires prior to the visit.
There was likely more to the problem, however. As noted above, there had been past studies of a similar format which indicated that such kinds of questionnaires could be effective in boosting shared decision-making and patient engagement.
Because of that, the researchers hypothesized that there was another reason for their unexpected results, such as a lack of provider engagement or an inability for clinicians to organically incorporate these topics into their care encounters.
Such proposals were supported by the empathy scores which the researchers also collected following patient provider encounters. Providers in the intervention group tended to receive lower empathy scores than providers in the control group. This may have been because it was difficult to seamlessly integrate conversation about quality of life into the appointment.
“That physicians struggle to incorporate nonstandard information into patient encounters has been documented by others,” Purkaple and colleagues wrote. “The information provided about goals may have made some physicians uncomfortable and thus less able to express empathy.”
Noting the issues with discussing quality of life and patient goals during the care encounter, it is clear that more training is required to enhance patient engagement and shared decision-making. The researchers proposed more training be done on the patient side, as they’re more likely to accept this kind of training and put it into action during their doctor’s appointments.
Ensuring that patient goal-setting and shared decision-making be supported during the care encounter is vital considering the shift medicine is making toward value-based and patient-centered care.
The researchers noted patient preferences for being involved in their own healthcare, explaining that giving patients an avenue by which they can contribute to their own care helps enhance the patient provider relationship.
“Allowing patients to express their personal goals creates a more equal interaction between patient and physician, in which both individuals are experts, one in medicine and the other in the desired outcomes of treatment,” the researchers concluded.
“When patients are key participants, they will likely be more willing to enter into honest communication, broadening the conversation and opening up a broader range of diagnostic and therapeutic options.”