Ideas, concerns, expectations, and effects on life (ICEE) in GP consultations: an observational study using video-recorded UK consultations

Patient assertiveness and visit outcome in primary care: An observational study

OBJECTIVES

In recent years, there has been growing attention to patient assertiveness in interactions with healthcare providers. This observational study examines patient assertiveness and visit outcomes during routine general practitioner (GP) visits in the Netherlands.

METHODS

Video-recorded visits (n = 189) were analysed using a systematic coding protocol.

RESULTS

Patients expressed a median of 2 assertive behaviours per visit (IQR, 1-3), with the majority being self-initiated. Around one in eight patients did not express any assertive behaviour during the visit. Assertiveness was most commonly demonstrated through introducing new topics, with disagreements and direct requests being less frequent. Patients whose visit outcome involved treatment or a referral had behaved assertively more often than those receiving advice or reassurance.

CONCLUSIONS

This study could serve as a starting point for assessing patient assertiveness in primary care.

IMPLICATIONS

These findings suggest that patient assertiveness influences the visit outcome, highlighting the need for future research to assess whether this leads to variations in care and care outcomes.

Exploring patient ideas, concerns, and expectations in surgeon-patient consultations

OBJECTIVES

This study explores patient perspectives (ideas, concerns, and expectations) in surgeon-patient consultations.

METHODS

We examined 54 video-recorded consultations using applied conversation analysis. Consultations took place from 2012 to 2017 in an Australian metropolitan hospital clinic centre and involved seven surgeons across six specialties.

RESULTS

Patient perspectives emerged in less than one third of consultations. We describe the initiation of and response to potential perspectives sequences, demonstrating how patients and surgeons co-construct these sequences when they do occur.

CONCLUSIONS

Findings suggest a need for greater attention to supporting patient agency through explicit pursuit of patient perspectives. The implications extend to the Calgary-Cambridge Guide, suggesting that it may benefit from a focus on active pursuit and appropriate responsiveness to patient perspectives.

PRACTICE IMPLICATIONS

This study highlights the need for surgeons to actively engage with the patient perspective offered in consultations, emphasising the importance of respect for the patient's knowledge and expectations to improve patient satisfaction and healthcare outcomes.

The association between restricted activity and patient outcomes in older adults: systematic literature review and meta-analysis

BACKGROUND

Restricted activity is a potential early marker of declining health in older adults. Previous studies of this association with patient outcomes have been inconclusive. This review aimed to evaluate the extent to which restricted activity is associated with decline in health.

METHODS

A search was conducted for studies including people over 65 years old which investigated the association between measures of restricted activity and hospitalisation, cognitive decline, and mortality. Following data extraction by two reviewers, eligible studies were summarised using Inverse Variance Heterogeneity meta-analysis.

RESULTS

The search identified 8,434 unique publications, with 11 eligible studies. Three measures of restricted activity were identified: bed rest, restricted movement, and dependency for activities of daily living (ADL). Three studies looked at hospitalisations, with two finding a significant association with bed rest or restricted movement and one showing no evidence of an association. Restricted activity was associated with a significant increase in mortality across all three measures (bed rest odds ratio [OR] 6.34, 95%CI 2.51-16.02, I2 = 76%; restricted movement OR 5.38 95%CI 2.60-11.13, I2 = 69%; general ADL dependency OR 4.65 95%CI 2.25-9.26, I2 = 84%). The significant heterogeneity observed could not be explained by restricting the analysis by length of follow-up, or measure of restricted activity. No meta-analysis was conducted on the limited evidence for cognitive decline outcomes.

CONCLUSIONS

Limited studies have considered the prognostic value of restricted activity in terms of predicting future declining health. Current evidence suggests restricted activity is associated with hospitalisation and mortality, and therefore could identify a group for whom early intervention might be possible.

Communication in Primary Healthcare: A State-of-the-Art Literature Review of Conversation-Analytic Research

We report the first state-of-the-art review of conversation-analytic (CA) research on communication in primary healthcare. We conducted a systematic search across multiple bibliographic databases and specialist sources and employed backward and forward citation tracking. We included 177 empirical studies spanning four decades of research and 16 different countries/health systems, with data in 17 languages. The majority of studies originated in United States and United Kingdom and focused on medical visits between physicians and adult patients. We generated three broad research themes in order to synthesize the study findings: managing agendas, managing participation, and managing authority. We characterize the state-of-the-art for each theme, illustrating the progression of the work and making comparisons across different languages and health systems, where possible. We consider practical applications of the findings, reflect on the state of current knowledge, and suggest some directions for future research. Data reported are in multiple languages.