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Patient-physician agreement on the content of CHD prevention discussions.

ABSTRACT: BACKGROUND:Little is known about agreement between patients and physicians on content and outcomes of clinical discussions. A common perception of content and outcomes may be desirable to optimize decision making and clinical care. OBJECTIVE:To determine patient-physician agreement on content and outcomes of coronary heart disease (CHD) prevention discussions. DESIGN:Cross-sectional survey nested within a randomized CHD prevention study. SETTING AND PARTICIPANTS:University internal medicine clinic; 24 physicians and 157 patients. METHODS:Following one clinic visit, we surveyed patients and physicians on discussion content, decision making and final decisions about CHD prevention. For comparison, we audio-recorded, transcribed and coded 20 patient-physician visits. We calculated percent agreement between patient/physician reports, patient/transcription reports and physician/transcription reports. We calculated Cohen's kappas to compare patient/physician perspectives. RESULTS:Patients and physicians agreed on whether CHD was discussed in 130 visits (83%; kappa = 0.55; 95% CI 0.40-0.70). When discussions occurred, they agreed about discussion content (pros versus cons) in 53% of visits (kappa = 0.15; 95% CI -0.01-0.30) and physicians' recommendations in 73% (kappa = 0.44; 95% CI 0.28-0.66). Patients and physicians agreed on final decisions to take medication in 78% (kappa = 0.58; 95% CI 0.45-0.71) and change lifestyle in 69% (kappa = 0.38; 95% CI 0.24-0.53). They agreed less often, 43% (kappa = 0.13; 95% CI -0.11-0.37) about degree of involvement in decision making. Audio-recorded results were similar, but showed very low agreement between transcripts and patients' and physicians' self-report on discussion content and decision making. CONCLUSIONS:Disagreements about clinical discussions and decision making may be common. Future work is needed to determine: how widespread such agreements are; whether they impact clinical outcomes; and the relative importance of the subjective experience versus objective steps of shared decision making.

SUBMITTER: Behrend L

PROVIDER: S-EPMC4043219 | biostudies-literature | 2011 Mar

REPOSITORIES: biostudies-literature

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Patient-physician agreement on the content of CHD prevention discussions.

Behrend Lindy L Maymani Hossein H Diehl Megan M Gizlice Ziya Z Cai Jianwen J Sheridan Stacey L SL

Health expectations : an international journal of public participation in health care and health policy 20110301

<h4>Background</h4>Little is known about agreement between patients and physicians on content and outcomes of clinical discussions. A common perception of content and outcomes may be desirable to optimize decision making and clinical care.<h4>Objective</h4>To determine patient-physician agreement on content and outcomes of coronary heart disease (CHD) prevention discussions.<h4>Design</h4>Cross-sectional survey nested within a randomized CHD prevention study.<h4>Setting and participants</h4>Univ ...[more]

PMID: 20673244

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Project description:BACKGROUND:The quality of patient-physician discussions about chronic kidney disease (CKD) in primary care has not been studied previously. STUDY DESIGN:Cross-sectional study. SETTINGS & PARTICIPANTS:We audiotaped encounters between 236 patients with hypertension and their primary care physicians (n = 40). PREDICTORS:Patient, physician, and encounter characteristics. OUTCOMES & MEASUREMENTS:We described the occurrence and characteristics (content, use of technical terms, and physician assessment of patient comprehension of new concepts) of CKD discussions. We assessed patient and physician characteristics associated with CKD discussion occurrence. RESULTS:Many patients (mean age, 59 years) had uncontrolled hypertension (51%), diabetes (44%), and/or 3 or more comorbid conditions (51%). Most primary care physicians practiced (52%) fewer than 10 years. CKD discussions occurred in few (26%; n = 61) encounters, with content focused on laboratory assessment (89%), risk-factor treatment (28%), and causes (26%) of CKD. In encounters that included a CKD discussion, physicians used technical terms (28%; n = 17) and rarely assessed patients' comprehension (2%; n = 1). CKD discussions were statistically significantly less common in visits of patients with some (vs no) college education (OR, 0.23; 95% CI, 0.09-0.56), with 3 or more (vs fewer) comorbid conditions (OR, 0.49; 95% CI, 0.25-0.96), and who saw physicians with more (vs fewer) than 10 years of practice experience (OR, 0.41; 95% CI, 0.21-0.80). CKD discussions were more common during longer encounters (OR, 1.31; 95% CI, 1.04-1.65) and encounters in which diabetes was (vs was not) discussed (OR, 2.87; 95% CI, 1.22-6.77). LIMITATIONS:Generalizability of our findings may be limited. CONCLUSIONS:Patient-physician discussions about CKD in high-risk primary care patients were infrequent. Physicians used technical terms and infrequently assessed patients' understanding of new CKD concepts. Efforts to improve the frequency and content of patient-physician CKD discussions in primary care could improve patients' clinical outcomes.

Project description:IntroductionLittle is known about whether patients and physicians perceive lung cancer screening (LCS) as a teachable moment to promote smoking cessation or the degree to which physicians in "real world" settings link LCS discussions with smoking cessation counseling. We sought to characterize patient and physician perspectives of discussions about smoking cessation during LCS.MethodsWe conducted a qualitative study (interviews and focus groups) with 21 physicians and 28 smokers screened in four diverse hospitals. Transcripts were analyzed for characteristics of communication about smoking cessation and LCS, the perceived effect on motivation to quit smoking, the degree to which physicians leverage LCS as a teachable moment to promote smoking cessation, and suggestions to improve patient-physician communication about smoking cessation in the context of LCS.ResultsPatients reported that LCS made them more cognizant of the health consequences of smoking, priming them for a teachable moment. While physicians and patients both acknowledged that smoking cessation counseling was frequent, they described little connection between their discussions regarding LCS and smoking cessation counseling. Physicians identified several barriers to integrating discussions on smoking cessation and LCS. They volunteered communication strategies by which LCS could be leveraged to promote smoking cessation.ConclusionsLCS highlights the harms of smoking to patients who are chronic, heavy smokers and thus may serve as a teachable moment for promoting smoking cessation. However, this opportunity is typically missed in clinical practice.ImplicationsLCS highlights the harms of smoking to heavily addicted smokers. Yet both physicians and patients reported little connection between LCS and tobacco treatment discussions due to multiple barriers. On-site tobacco treatment programs and post-screening messaging tailored to the LCS results are needed to maximize the health outcomes of LCS, including smoking quit rates and longer-term smoking-related morbidity and mortality.

Project description:ImportanceThe emerging paradigm of treat-to-target in psoriasis requires accurate monitoring of treatment response. The commonly used physician global assessment tool does not capture the patient's perception of their disease. Patient assessments facilitate shared decision-making and foster patient-centered care; however, recent research reports a discordance between patient- and physician-reported psoriasis severity. Understanding the factors underlying this discordance may improve treatment satisfaction and disease outcomes.ObjectivesTo evaluate the discordance between patient- and physician-reported measures of psoriasis severity and assess the association with patient mental health status.Design, setting, and participantsA cohort study using repeated cross-sectional analysis of real-world longitudinal data was conducted at a large specialist psoriasis service serving London and Southeast England. A total of 502 patients attending the psoriasis service between May 12, 2016, and November 1, 2018, were included. Data analysis was conducted July 22 to October 22, 2019.Main outcomes and measuresPsoriasis severity was assessed on each visit with identical 5-point physician and patient global assessment scales (clear/nearly clear, mild, moderate, severe, and very severe). Each patient completed validated self-report screens for depression and anxiety on each visit.ResultsLongitudinal data from 502 individuals with psoriasis (1985 total observations) were available. A total of 339 patients (68%) were men, 396 (79%) were White, mean (SD) age was 47 (13) years, and 197 patients (39%) had concurrent psoriatic arthritis, 43 (9%) screened positive for depression, and 49 (10%) screened positive for anxiety. There was discordance between physician and patient measures of disease severity in 768 of 1985 office appointments (39%); on 511 visits (26%) patients rated their psoriasis as less severe and on 257 visits (13%) patients rated their psoriasis as more severe compared with their physician. Individuals who screened positive for depression or anxiety were more likely to overestimate their psoriasis severity compared with their physician (relative risk ratio: depression, 2.7; 95% CI, 1.6-4.5; anxiety, 2.1; 95% CI, 1.3-3.4). These findings remained statistically significant after adjustment for age, ethnicity, sex, body mass index, smoking, number of comorbidities, treatment modality, and presence of psoriatic arthritis.Conclusions and relevanceThe findings of this cohort study suggest that discordance between patient and physician assessments of psoriasis severity is associated with patients' mental health status. Recognition of anxiety and depression in individuals with psoriasis appears to be important when interpreting patient-reported outcome measures and informing appropriate treatment decisions.

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Patient-physician agreement on the content of CHD prevention discussions.

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Patient-physician agreement on the content of CHD prevention discussions.

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