Review article
Patient feedback questionnaires to enhance consultation skills of healthcare professionals: A systematic review

https://doi.org/10.1016/j.pec.2018.03.016Get rights and content

Highlights

  • Several patient feedback questionnaires are available.

  • Most patient feedback questionnaires are designed specifically for physicians.

  • Patient feedback questionnaires need to be validated with different practitioners.

  • Patient feedback can help in enhancing consultation skills of practitioners.

Abstract

Objective

To identify patient feedback questionnaires that assess the development of consultation skills (CSs) of practitioners.

Methods

We conducted a systematic search using seven databases from inception to January 2017 to identify self-completed patient feedback questionnaires assessing and enhancing the development of CSs of individual practitioners. Results were checked for eligibility by three authors, and disagreements were resolved by discussion. Reference lists of relevant studies and Open Grey were searched for additional studies.

Results

Of 16,312 studies retrieved, sixteen were included, describing twelve patient feedback questionnaires that were mostly designed for physicians in primary care settings. Most questionnaires had limited data regarding their psychometric properties, except for the Doctor Interpersonal Skills Questionnaire (DISQ). Most studies conducted follow-up, capturing positive views of practitioners regarding the process (n = 14). Feedback was repeated by only three studies, demonstrating different levels of improvement in practitioners’ performance.

Conclusion

Identified questionnaires were mainly focused on physicians, however, to support using patient feedback, questionnaires need to be validated with other practitioners.

Practice implications

Several patient feedback questionnaires are available, showing potential for supporting practitioners’ development. Valid questionnaires should be used with appropriate practitioners in developing more evidence for the impact they may have on actual consultations.

Introduction

Good consultation skills (CSs) are essential for effective patient encounters and it has been shown to drive positive outcomes including enhancing patient adherence and satisfaction [[1], [2], [3], [4], [5], [6]]. An emphasis was given by the British Medical Association (BMA) and the General Medical Council (GMC) indicating the importance for the quality of the physician’s professional work to be assessed at regular intervals, by patients and colleagues [7], thus supporting their continuous professional development [[8], [9]]. Numerous methods are described in the literature regarding the assessment of practitioners’ consultations skills, including assessments conducted by assessors [10], peers [[11], [12], [13]], or by patients [[14], [15], [16], [17]]. A combination of methods are suggested to provide a more holistic assessment [[18], [19], [20]]. However, collecting feedback from patients is probably the most suitable method [21]. Patients, as customers of the healthcare system are capable of highlighting weak areas of performance that are not usually covered by other conventional methods [[6], [22]], or not recognised by practitioners themselves [23].

Patient feedback can be collected using questionnaires and/or by conducting interviews [[24], [25]]. However, the full benefit of feedback can only be realised by using it to support professionals’ development. It can help practitioners to better understand their skills, acknowledge their strengths, identify areas needing further attention, and thus directing them to where improvements are needed [[26], [27], [28]].

Using feedback collected from patients to enhance the CSs of individual practitioners is not thoroughly studied. Initial searches identified two systematic reviews that investigated this domain [[29], [30]]. While these reviews identified several feedback questionnaires, they were focused on assessing CSs of physicians. However, patient consultations are currently conducted by a wide variety of different practitioners and not only by physicians. For example, in the UK since 2005, several practitioners are legally allowed to prescribe medications to patients, including nurses and pharmacists [[31], [32], [33]], thus the number of patient consultations has greatly increased. Therefore, this systematic review was conducted to identify patient feedback questionnaires used to assess and enhance the development of individual CSs of all practitioners across all settings.

This review aimed to identify and describe patient feedback questionnaires that assess the development of CSs of individual practitioners. The objectives were to describe identified studies and questionnaires according to the following: (a) name of the questionnaire, (b) practitioners assessed, (c) assessment setting, (d) questionnaire administration method (patient recruitment, individual in charge of administration, and concealment methods), (e) patient feedback reporting methods, (f) follow up to patient feedback and its impact.

Section snippets

Literature search

A systematic search was conducted to identify relevant studies using the following databases: MEDLINE, EMBASE, AMED (via Ebsco), Web of Science, SCOPUS, CINAHL, and PsycInfo, from inception of the databases up to January 2017. A protocol was developed and registered on the international database of prospectively registered systematic reviews (PROSPERO) (CRD42017055365). Search results were limited by two filters: English language and publication type: journal, and they were exported into the

Results

The search process is presented in the PRISMA flow diagram in Fig. 1. A total of sixteen studies were included in the review.

Summary of main results

To our knowledge, this is the first systematic review that identified patient feedback questionnaires assessing CSs of all practitioners in all settings. Sixteen studies were identified. The majority of studies were similar in terms of their design, setting, methods of patient recruitment and feedback reporting to practitioners. Results were generally positive, however, they were mostly reflecting the views of practitioners regarding feedback process, without actually measuring the extent of

Conflict of interest

None

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author contributions

HA, MT and JD contributed to the design of the review. HA and SS assessed the quality of included studies. HA drafted the manuscript and all authors revised and approved its final version.

References (102)

  • D.G. Safran et al.

    Linking primary care performance to outcomes of care

    J. Fam. Pract.

    (1998)
  • P. Kinnersley et al.

    The patient-centredness of consultations and outcome in primary care

    Br. J. Gen. Pract.

    (1999)
  • R.C. Maly et al.

    A randomized controlled trial of facilitating information giving to patients with chronic medical conditions effects on outcomes of care

    J. Fam. Pract.

    (1999)
  • A. Bredart et al.

    Doctor-patient communication and satisfaction with care in oncology

    Curr. Opin. Oncol.

    (2005)
  • General Medical Council

    Colleague and Patient Feedback for Revalidation

    (2018)
  • A. Brownlea

    Earning confidence: perspectives for a modernising NHS

    J Clin Excellence

    (2001)
  • General Medical Council

    Supporting Information for Appraisal and Revalidation

    (2012)
  • R.J. Howells et al.

    Assessment of doctors’ consultation skills in the paediatric setting: the Paediatric Consultation Assessment Tool

    Br. Med. J.

    (2010)
  • P.G. Ramsey et al.

    Use of peer ratings to evaluate physician performance

    J. Am. Med. Assoc.

    (1993)
  • J.J. Norcini

    Peer assessment of competence

    Med. Educ.

    (2003)
  • J.L. Campbell et al.

    Assessing the professional performance of UK doctors: an evaluation of the utility of the General Medical Council patient and colleague questionnaires

    Qual. Saf. Health Care

    (2008)
  • M. Greco et al.

    Real-patient evaluation of communication skills teaching for GP registrars

    Fam. Pract.

    (1998)
  • M. Greco et al.

    Impact of patient feedback on the interpersonal skills of general practice registrars: results of a longitudinal study

    Med. Educ.

    (2001)
  • A.G. Espinel et al.

    What parents say about their child’s surgeon: parent-reported experiences with pediatric surgical physicians

    J. Am. Med. Assoc.

    (2014)
  • F. Kamangar et al.

    360-degree Evaluations on Physician Performance as an Effective Tool for Interprofessional Teams: a critical analysis of physician self-assessment as compared to nursing staff and patient evaluations of providers

    Dermatol. Online J.

    (2016)
  • S.K. Vinod et al.

    Multisource feedback for radiation oncologists

    J. Med. Imaging Radiat. Oncol.

    (2013)
  • R. Baker

    Development of a questionnaire to assess patients’ satisfaction with consultations in general practice

    Br. J. Gen. Pract.

    (1990)
  • J. Labarere et al.

    Development of a French inpatient satisfaction questionnaire

    Int. J. Qual. Health Care

    (2001)
  • E. Zarei

    Service quality of hospital outpatient departments: patients’ perspective

    Int. J. Health Care Qual. Assur.

    (2015)
  • P.D. Cleary

    The increasing importance of patient surveys

    Br. Med. J.

    (1999)
  • T.L. Delbanco

    Enriching the doctor-patient relationship by inviting the patient's perspective

    Ann. Inter. Med.

    (1992)
  • K. Tasa et al.

    Using patient feedback for quality improvement

    Qual. Manage. Health Care

    (1996)
  • M.N. Marshall et al.

    The public release of performance data

    J. Am. Med. Assoc.

    (2000)
  • R.G. Evans et al.

    Assessing the practising physician using patient surveys: a systematic review of instruments and feedback methods

    Fam. Pract.

    (2007)
  • M.E. Reinders et al.

    The effect of patient feedback on physicians' consultation skills: a systematic review

    Acad. Med.

    (2011)
  • A.P. Tonna et al.

    Pharmacist prescribing in the UK–a literature review of current practice and research

    J. Clin. Pharm. Ther.

    (2007)
  • R. Cooper et al.

    Nonmedical prescribing in the United kingdom: developments and stakeholder interests

    J. Ambul. Care Manage.

    (2008)
  • Department of Health

    Improving Patients’ Access to Medicines: A Guide to Implementing Nurse and Pharmacist Independent Prescribing Within the NHS in England

    (2008)
  • National Institutes of Health

    National Heart Lung and Blood Institute, Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies – NHLBI

    (2018)
  • M.H. Woolford et al.

    Unexplained absences and risk of death and injury among nursing home residents: a systematic review

    J. Am. Med. Dir. Assoc.

    (2017)
  • M.J. Greco et al.

    Utilising patient feedback in the RACGP training program. An exploratory study

    Aust. Fam. Physician

    (1995)
  • M. Jenkins et al.

    The assessment of general practitioner registrars’ consultations by a patient satisfaction questionnaire

    Med. Teach.

    (1996)
  • W. Hall et al.

    Assessment of physician performance in Alberta the physician achievement review

    Can. Med. Assoc. J.

    (1999)
  • M. Greco et al.

    Patient assessment of interpersonal skills: a clinical governance activity for hospital doctors and nurses

    J. Clin. Excellence

    (2001)
  • J.M. Sargeant et al.

    Responses of rural family physicians and their colleague and coworker raters to a multi-source feedback process: a pilot study

    Acad. Med.

    (2003)
  • L. Mackillop et al.

    Collaborating with patients and carers to develop a patient survey to support consultant appraisal and revalidation

    Clin. Manage.

    (2006)
  • M. Greco et al.

    Incorporating patient feedback into vocational training: an interpersonal skills development exercise for GP trainers and registrars

    Educ. Prim. Care

    (2001)
  • R.S. Lipner et al.

    The value of patient and peer ratings in recertification

    Acad. Med.

    (2002)
  • A.K. Al-Shawi et al.

    Patient assessment of surgeons’ interpersonal skills: s tool for appraisal and revalidation

    Clin. Governa.: Int. J.

    (2005)
  • C. Violato et al.

    Fidler Changes in performance: a 5-year longitudinal study of participants in a multi-source feedback programme

    Med. Educ.

    (2008)
  • Cited by (10)

    View all citing articles on Scopus
    View full text