When patients have more than one concern

doi:10.1016/j.pec.2016.03.016

Patient Education and Counseling

Volume 99, Issue 5, May 2016, Page 671

https://doi.org/10.1016/j.pec.2016.03.016 Get rights and content

References (5)

J.D. Robinson
Closing medical encounters: two physician practices and their implications for the expression of patients’ unstated concerns
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(2001)
J.D. Robinson et al.
Agenda-setting revisited: when and how do primary-care physicians solicit patients’ additional concerns?
Patient Educ. Couns.
(2016)

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Cited by (5)

Delivering remote consultations: Talking the talk
2021, Musculoskeletal Science and Practice
Citation Excerpt :
This recognises their issues may be multifactorial, as evidenced by the EPaC (Elicitation of Patient Concerns) study in the UK, where an analysis of 185 primary care traditional video-recordings with GPs revealed an average of 2.1 concerns were raised per 10-min scheduled appointment (Stuart et al., 2019). Seeking any additional issues at this point in the consultation may help prevent ‘door-knob concerns’, where the patient is metaphorically on their way out with their hand on the door knob, and an additional concern surfaces, often the most important one (Finset, 2016), or they leave with unmet needs. In primary care, unvoiced health concerns have been associated with worsening of symptoms, increased patient anxiety, the need for additional visits and increased burden and costs (in time and resources) both for patients and the service (Heritage et al., 2007; Stuart et al., 2019).
There is an increasing affinity for remote health consultations (including telephone and virtual platforms), enabling new models of accessing services to evolve. Whilst many key skills are transferable from traditional to remote consultations, there is even greater emphasis on verbal communication skills during these interactions.
This masterclass considers the communication skills required for delivering remote health care consultations, in particular focussing on: 12 interactional features in an opening sequence of a remote call; active listening; how to offer advice using the Ask-Offer-Ask framework; and subtleties in phrasing and prosody when closing a call that may indicate a level of satisfaction (or otherwise).
In planning for digitally-enabled services to become mainstream, the differences in communication between remote and face-to-face consultations must be recognised and embraced.
Patient priorities and the doorknob phenomenon in primary care: Can technology improve disclosure of patient stressors?
2018, Patient Education and Counseling
Citation Excerpt :
When patients do discuss their priorities, it is often relegated to the end of the visit, when the physician asks, with their hand already on the doorknob, “is there anything else you wanted to discuss?” This situation, in which the patient finally reveals the underlying concern, has been referred to as the “doorknob phenomenon” [21,22]. In certain circumstances, the late disclosure can lead to an entirely different diagnosis, in others it might alter the treatment plan.
Patients with multiple chronic conditions face many stressors (e.g. financial, safety, transportation stressors) that are rarely prioritized for discussion with the primary care provider (PCP). In this pilot randomized controlled trial we examined the effects of a novel technology-based intervention called Customized Care on stressor disclosure.
The main outcomes were stressor disclosure, patient confidence and activation, as assessed by self-report and observational methods (transcribed and coded audio-recordings of the office visit).
Sixty patients were enrolled. Compared with care as usual, intervention patients were 6 times more likely to disclose stressors to the PCP (OR = 6.16, 95% CI [1.53, 24.81], p = 0.011) and reported greater stressor disclosure confidence (exp[B] = 1.06, 95% CI [1.01, 1.12], p = 0.028). No differences were found in patient activation or the length of the office visit.
Customized Care improved the likelihood of stressor disclosure without affecting the length of the PCP visit.
Brief technology-based interventions, like Customized Care could be made available through patient portals, or on smart phones, to prime patient-PCP discussion about difficult subjects, thereby improving the patient experience and efficiency of the visit.
Dealing with requests for euthanasia in incompetent patients with dementia. Qualitative research revealing underexposed aspects of the societal debate
2023, Age and Ageing
How physicians respond to the emotional expressions of people with cancer
2023, Psicooncologia
Agenda navigation in consultations covering multiple topics. A qualitative case study from general practice
2021, Scandinavian Journal of Primary Health Care

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From the EditorWhen patients have more than one concern

Soc. Sci. Med.

Patient Educ. Couns.

From the Editor
When patients have more than one concern