Prospective randomised clinical trial of providing patients with audiotape recordings of their oesophagogastric cancer consultations

OBJECTIVE: To evaluate audiotape-recorded consultations at which a new diagnosis of oesophageal or gastric cancer was given to patients with reference to information retention, psychological outcome and socio-economic deprivation. METHODS: Fifty-eight patients were randomised to receive audiotaped consultations or not. Thirty-one patients received tapes (12 oesophageal and 19 gastric cancers) and were compared with 27 control patients (12 oesophageal and 15 gastric cancers). All patients were re-interviewed and completed a hospital anxiety and depression (HAD) questionnaire. Socio-economic deprivation scores were calculated using National Indices of Multiple Deprivation. RESULTS: Patients randomised to receive tapes were more likely to retain information (31 patients) than control patients (18 patients, p=0.001). Median (range) HAD scores were similar in both groups of patients [HAD A tape 6 (0-21) vs. no tape 5 (2-14), HAD D tape 3 (0-23) vs. 4 (0-10), respectively]. Deprivation correlated significantly with higher HAD A scores in control patients (p=0.039) but was not associated with information retention (p=0.667). CONCLUSION: Taped consultations were associated with significantly better information retention without adverse psychological outcomes. Providing an audiotape may reduce the effect of socio-economic deprivation on patient anxiety. PRACTICE IMPLICATIONS: Audiotaping, or its equivalent, would be a valuable tool in the multidisciplinary approach to cancers of the upper gastrointestinal tract.     

The content of general practice consultations: cross-sectional study based on video recordings

Background

Demographic and policy changes appear to be increasing the complexity of consultations in general practice.

Aim

To describe the number and types of problems discussed in general practice consultations, differences between problems raised by patients or doctors, and between problems discussed and recorded in medical records.

Design and setting

Cross-sectional study based on video recordings of consultations in 22 general practices in Bristol and North Somerset.

Method

Consultations were examined between 30 representative GPs and adults making a pre-booked day-time appointment. The main outcome measures were number and types of problems and issues discussed; who raised each problem/issue; consultation duration; whether problems were recorded and coded.

Results

Of 318 eligible patients, 229 (72.0%) participated. On average, 2.5 (95% CI = 2.3 to 2.6) problems were discussed in each consultation, with 41% of consultations involving at least three problems. Seventy-two per cent (165/229) of consultations included problems in multiple disease areas. Mean consultation duration was 11.9 minutes (95% CI = 11.2 to 12.6). Most problems discussed were raised by patients, but 43% (99/229) of consultations included problems raised by doctors. Consultation duration increased by 2 minutes per additional problem. Of 562 problems discussed, 81% (n = 455) were recorded in notes, but only 37% (n = 206) were Read Coded.

Conclusion

Consultations in general practice are complex encounters, dealing with multiple problems across a wide range of disease areas in a short time. Additional problems are dealt with very briefly. GPs, like patients, bring an agenda to consultations. There is systematic bias in the types of problems coded in electronic medical records databases.     

Digital audio recordings improve the outcomes of patient consultations: A randomised cluster trial

ObjectivesTo investigate the effects on patients’ outcome of the consultations when provided with: a Digital Audio Recording (DAR) of the consultation and a Question Prompt List (QPL).MethodsThis is a three-armed randomised controlled cluster trial. One group of patients received standard care, while the other two groups received either the QPL in combination with a recording of their consultation or only the recording. Patients from four outpatient clinics participated: Paediatric, Orthopaedic, Internal Medicine, and Urology. The effects were evaluated by patient-administered questionnaires.ResultsA total of 4349 patients participated in the study. DAR significantly increased the probability of fulfilling the participants’ self-perceived information needs by 4.1% to 6.3%, particularly with regard to test results (OR = 1.41, 95%CI: 1.14-1.74, p = 0.001) and treatment options (OR = 1.39, 95%CI: 1.13-1.71, p = 0.002). Additionally, the interventions positively influenced the participants’ satisfaction with the treatment, their relationship with the health professional, and their experience of being involved in the decision-making.ConclusionProviding outpatients with a QPL and DAR of their consultation positively influences the patients’ perception of having adequate information after the consultation.Practice implicationsThe implementation of a QPL and audio recording of consultations should be considered in routine practice.     

Patient satisfaction with primary-care consultations

This study examines patients' perceptions of their latest consultation with a primary-care physician. A new questionnaire measured patients' views on their ideal physician prior to the visit and their satisfaction on similar dimensions immediately afterward. Ratings by the 503 eligible patients (87% response rate) showed that all 43 items were relevant and that a shortened version could also be used successfully. Patients held high expectations for, but were also quite satisfied with, their physicians' actual behavior during the consultation. Factor analysis of perceptions supported other research findings and raised some anomalies in relation to overordering of investigations and waiting time. Other analyses showed which characteristics of physicians and patients were most influential on satisfaction and which dimensions of care were common or distinct to the 22 physicians involved in this study.The authors acknowledge the cooperation shown by all patients, general practitioners, and their receptionists in this study. They also thank the interviewers and hospital staff who collected data in the pilot and main studies. Financial support came from a Faculty of Medicine Research Grant to Professors S. Leeder, R. Clarke, and C. Engel, who also took the first steps to develop a questionnaire for measuring patients' satisfaction with Newcastle medical students. Data coding and analyses were conducted by Mary Fowler and David Firman, using the University of Newcastle computing services and educational statistics packages adapted for use by Dr. Alan Smith.     

Recalibration of audiovisual simultaneity

To perceive the auditory and visual aspects of a physical event as occurring simultaneously, the brain must adjust for differences between the two modalities in both physical transmission time and sensory processing time. One possible strategy to overcome this difficulty is to adaptively recalibrate the simultaneity point from daily experience of audiovisual events. Here we report that after exposure to a fixed audiovisual time lag for several minutes, human participants showed shifts in their subjective simultaneity responses toward that particular lag. This 'lag adaptation' also altered the temporal tuning of an auditory-induced visual illusion, suggesting that adaptation occurred via changes in sensory processing, rather than as a result of a cognitive shift while making task responses. Our findings suggest that the brain attempts to adjust subjective simultaneity across different modalities by detecting and reducing time lags between inputs that likely arise from the same physical events.     

Utilization of the postmortem examination with emphasis on audiovisual aids

With the present trend in decreased requests for autopsies to be performed, the method of plastination and videotaping coupled with more traditional teaching methods provides a way to expand the information and knowledge that may be obtained from each autopsy in an academic medical center. Plastinated specimens and videotapes can be retained on a permanent basis to be used over and over, with nearly the same impact as the original autopsy.