The purpose of this controlled pilot study is to determine whether an intervention aimed at patients will improve partnering, shared decision-making and open communication. Results from this pilot study will inform how to best proceed with a larger multi-centered randomized controlled trial. The specific hypothesis for this pilot study is to: 1. Test the feasibility of a simple patient-centered intervention. 2. Test the correlation between patient readiness to actively engage in conversation (assessed using a pre-visit patient survey) and actual patient behaviors in the encounter. 3. Develop a coding tool that will quantify patient activation in clinical encounters. 4. Test whether activating patients who are more involved and revealing in the patient-clinician dyad will improve patient and clinician outcomes.
Chronic illness requires a greater participation by the patient in the management of their own disease process. Patients now increasingly find themselves dealing with multiple illnesses over the span of their lifetime. Patient-provider communication is key to optimal patient outcomes. Numerous studies have shown adverse effects of poor communication on a number of outcomes, including patient and provider satisfaction as well as medical compliance and health related outcomes. An important next step in this field is to study whether it is possible to improve chronic illness care in real world settings by improving the quality of patient-provider interaction through feasible interventions focused on efficient, motivational, and empathic communication, targeted at both patients and providers. There is little information on the best patterns of communication in dealing with patients with multiple comorbidities. The investigators believe that an optimal healing relationship between these patients and their healthcare providers includes shared decision-making, partnering between patients and clinicians to foster health and healthy behaviors in an environment of trust, and effective open communication. An important outcome for this pilot study is feasibility. The investigators intend to conduct a follow-up multi-centered trial; planning and budgeting for such a trial will require information gleaned from this study. What is the rate of accrual and how many patients can realistically be enrolled and followed within the current study personnel. What outcomes are sensitive to change and how much change can the investigators expect to see? Will this intervention effect change in patient behavior? This study will give us insight to allow us to build a right-sized project.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
DOUBLE
Enrollment
106
The instrument is completed before the scheduled appointment and is designed to prompt patients to reflect on their specific goals for the medical encounter, prioritize those goals, and to "Prime" them to engage in a discussion centered on their concerns and expectations. In addition, participants will be encouraged to bring this form into their physician visit and use it to engage their clinician in a discussion about their health needs.
Walter Reed National Medical Military Center (WRNMMC)
Bethesda, Maryland, United States
Degree of shared medical decision-making
Assessed from transcribed audio-tapes of the doctor-patient encounter using Roter Interaction Analysis System (RIAS).
Time frame: Baseline
Adherence to anti-hypertensive drug treatment at baseline
This outcome will be assessed using pill counts by the pharmacists.
Time frame: Baseline
Adherence to anti-hypertensive drug treatment at one month
This outcome will be assessed using pill counts by the pharmacists.
Time frame: One month
Adherence to anti-hypertensive drug treatment at three months
This outcome will be assessed using pill counts by the pharmacists.
Time frame: Three months
Patient satisfaction
Post-encounter survey using the validated Rand-9 Patient Satisfaction Tool
Time frame: Baseline
Clinician rating of patient as "difficult"
Clinician Rating of the Encounter Using the Difficult Doctor-Patient Relationship Questionaire (DDPRQ).
Time frame: Baseline
Patient Trust in their physician at baseline
Validated Trust in Physician (11-item) Instrument
Time frame: Baseline
Patient Trust in their physician at one month
Validated Trust in Physician (11-item) Instrument
Time frame: one month
Patient Trust in their physician at three months
Validated Trust in Physician (11-item) Instrument
Time frame: Three months
Systolic and Diastolic Blood Pressure at baseline
Each blood pressure data point was the average of 3 measurements measured 5 minutes apart while seated.
Time frame: Baseline
Systolic and Diastolic Blood Pressure at one month
Each blood pressure data point was the average of 3 measurements measured 5 minutes apart while seated.
Time frame: One month
Systolic and Diastolic Blood Pressure at three months
Each blood pressure data point was the average of 3 measurements measured 5 minutes apart while seated.
Time frame: three months
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