Review
Question Prompt Lists in health consultations: A review

https://doi.org/10.1016/j.pec.2015.05.015Get rights and content

Highlights

  • A physician-endorsed QPL can increase patient question asking in consultations.

  • Physicians may provide more information to patients when a QPL is addressed.

  • Further research is required to assess the optimal length of a QPL.

  • The adaptation of QPLs for cultural and special needs groups is required.

Abstract

Objectives

This review examines the use and effectiveness of Question Prompt Lists (QPL) as communication aids to enhance patient question asking, information provision to patients and patient participation in health and medical consultations.

Methods

A systematic search was undertaken to identify relevant literature concerning QPLs including academic databases, Google-based and snowball searching. Forty-two relevant studies reporting 50 interventions were identified.

Results

Although findings varied there was some evidence that a QPL endorsed by the physician increased total question asking. Using a QPL increased question asking concerning specific content areas (e.g. prognosis). There was some evidence that physicians provided more information during consultations. There were no consistent findings concerning effects on patient knowledge recall, anxiety and satisfaction or consultation time. Some interventions that increased question asking had longer consultation times.

Conclusion

There is evidence that an appropriate QPL, endorsed by the physician and provided immediately before the consultation, may increase patient question asking and lead to more information being provided by the physician.

Practice implications

There is increasing evidence to support QPL use in routine practice. Further trials might address the issues identified including an assessment of QPL optimal length and QPL adaptation for cultural and special needs groups.

Introduction

Central to evidence based and outcomes focussed health care, is the imperative to provide patients with information about alternative treatments for their health condition and the opportunity to participate in decision making concerning their health condition [1], [2]. A growing research literature concerns the use of Question Prompt Lists (QPL) as one method to enhance communication between the patient/consumer and the treating clinician. The authors were commissioned by a government agency to undertake a rapid review on this topic.

Question Prompt Lists can be a prepared list of questions provided to the patient by the care team, where the patient selects those questions they wish to ask the doctor (QPL). Alternatively, the patient may be asked to generate their own list of questions prior to the consultation (PQPL). Sometimes a patient may be given a health card or a patient agenda form with a list of topics for the patient to consider when asking questions. In this review each of these types of interventions is considered to be a QPL. The focus of this review is only on QPL use and it does not include a review of other communication or decision making aids and tools.

The purpose of a QPL is to support patients in seeking information concerning their diagnosis and treatment; to address their concerns; to enhance the communication between the patient/consumer and the treating clinician; to promote patient participation; and to potentially enhance shared decision making within the health consultation.

Shepherd et al. [3] noted that patients need tailored information from their health care professionals about treatment and test options, including their risks and benefits and the likelihood of these occurring in order to achieve informed consent and to make informed health care decisions. They stated that provision of reliable and accurate information is part of high quality patient-centred care, promotes evidence based practice, may improve both the experience and outcomes of care and has been endorsed in patient charters.

If a QPL can be shown to be effective then it becomes a simple and efficient means of enhancing patient question asking and participation in the consultation [4]. QPL use aligns well with recent initiatives to enhance shared decision making in health and medical consultations [5].

Earlier reviews related to the use of communication aids examined interventions (including some QPL studies) to help patients address their information needs. They suggested the effects of a QPL included a small but significant increase in patient question asking and patient satisfaction [6], a positive effect on recall of medical information, an increase in patient knowledge [7], and an increase in provision of information about prognosis [8]. More recent reviews have focussed on cancer patients [9], [10]. As the body of research relating to QPL use is increasing this review examines current evidence on the use and effectiveness of QPLs as communication aids to enhance patient question asking, information provision to patients and patient participation in health and medical consultations.

Section snippets

Search strategy

A ‘rapid’ review [11] using a comprehensive search strategy was implemented to identify research articles relating to QPL interventions. The PRISMA guidelines were referred to in conducting and reporting the literature search and review process [12].

Peer reviewed literature was identified using the academic databases: MEDLINE, PsycINFO, CINAHL, Scopus, ProQuest and Cochrane Collaboration. Search terms used were:

  • 1.

    “question prompt list” or “question prompt sheet”,

  • 2.

    “patient questions” or “question

Results

Fig. 1 displays the results of the search strategy. Of the 199 articles included in the review there were 42 publications reporting 50 interventions that examined the implementation of a QPL in relation to key outcome variables; the prime focus of this review. The remaining 157 articles mentioned the use of a QPL, described their development, or discussed usability aspects.

Table 1, Table 2 provide summaries of the articles describing single and multiple intervention studies. Although there are

Discussion

Overall the literature suggests that research on the effectiveness of QPL interventions is still at an early stage, with suggestive rather than definitive findings. There is reasonable evidence that an appropriately designed and relevant QPL, endorsed by the physician, and provided immediately before the health consultation, may increase patient question asking in consultations, and may lead to more information being provided by the doctor in these consultations.

A key issue is whether the

Role of the Funding Source

The Australian Commission on Safety and Quality in Health Care commissioned and funded the project, provided the brief and gave editorial feedback on this review.

Conflict of Interest

The University of Wollongong received a grant from the declared funding body. None of the authors had any potential conflicts of interest including any financial, personal or other relationships with the funding organization or other people or organizations within 3 years of beginning the submitted work that could inappropriately influence, or be perceived to influence, their work.

Acknowledgements

The authors wish to acknowledge the assistance of Peter Samsa for his assistance with the production of the literature review. The brief for this project was developed by the Australian Commission on Safety and Quality in Health Care, the organisation that commissioned and funded the review.

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