Promoting patient participation and shortening cancer consultations: a randomised trial
Open accessAbstract
Patient participation in medical consultations has been demonstrated to benefit their subsequent psychological well being. Question asking is one way in which patients can be active. We investigated 2 means of promoting cancer patient question asking. One was the provision of a question prompt sheet to patients prior to their initial consultation with their oncologist. The second was the active endorsement and systematic review of the question prompt sheet by their oncologist. 318 patients with heterogeneous cancers, seeing one of 5 medical and 4 radiation oncologists for the first time, were randomised to either receive or not receive a question prompt sheet. Doctors were randomised to either proactively address or passively respond to the question prompt sheet in the subsequent consultation. Anxiety was assessed prior to the consultation. Consultations were audiotaped and content analysed. Anxiety was assessed again immediately following the consultation. Within the next 10 days patients completed questionnaires assessing information needs, anxiety and satisfaction and were given a structured telephone interview assessing information recall. Patients provided with a question prompt sheet asked more questions about prognosis compared with controls and oncologists gave significantly more prognostic information to these patients. Provision of the question prompt sheet prolonged consultations and increased patient anxiety; however, when oncologists specifically addressed the prompt sheet, anxiety levels were significantly reduced, consultation duration was decreased and recall was significantly improved. A patient question prompt sheet, used proactively by the doctor, is a powerful addition to the oncology consultation.
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Outcome data were complete in only six of the included studies.
“Outcome data were complete in only six studies (Brown 2001; Fallowfield 2002; Ho 2008; Robins 1989; Song 2005; Thom 1999 ).”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Brown 2001
We judged sequence allocation and/or concealment to be adequate in six other studies, even though they were only partially described.
“We judged sequence allocation and/or concealment to be adequate in six other studies, even though they were only partially described (Alder 2007; Brown 2001; Glasgow 2004; Haskard 2008; Hobma 2006; Pill 1998).”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Brown 2001
The remaining six studies were randomized by patient.
“and the remaining six were randomized by patient (Brown 2001; McLean 2004; Smith 2006; Song 2005; Sorlie 2007; Wolf 2008).”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Brown 2001
In Brown 2001, the consultation length for providers trained to be patient-centred was shorter than for those given prompt sheets without training.
“In Brown 2001, the consultation length for providers who were trained to be patient‐centred was shorter than for those who were given prompt sheets without training.”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Brown 2001
All five studies that measured consultation process outcomes reported at least one consultation process outcome in favour of the intervention.
“and all of these (Brown 2001; Glasgow 2004; Kinmonth 1998; Krones 2008; Loh 2007) reported at least one consultation process outcome in favour of the intervention.”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Brown 2001
In Brown 2001, patients with prompt sheets whose doctors were trained recalled significantly more information in total than those whose doctors were not trained (P = 0.036).
“Similarly, patients with prompt sheets whose doctors were trained recalled significantly more information in total than those whose doctors were not trained (P = 0.036).”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Brown 2001
In Brown 2001, patients with prompt sheets alone were significantly more anxious than patients with trained doctors.
“Patients with prompt sheets alone were significantly more anxious than patients with trained doctors.”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Brown 2001
In Brown 2001, patients of untrained providers were significantly more anxious than patients of trained providers.
“Patients of untrained providers were significantly more anxious than patients of trained providers.”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Brown 2001
The intervention resulted in at least one positive outcome in three of the six studies (Brown 2001; Dijkstra 2006; Kinmonth 1998).
“the intervention resulted in at least one positive outcome in three of these studies (Brown 2001; Dijkstra 2006; Kinmonth 1998).”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Brown 2001
In Brown 2001, among patients with prompt sheets, patients of trained doctors recalled significantly more information about treatment issues and side effects.
“For example, Brown 2001 assessed from audiotapes of patient question asking, information needs, and information recall and found that among patients with prompt sheets, patients of trained doctors recalled significantly more information about treatment issues and side effects.”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Brown 2001
Five of the six studies in intervention category 4 assessed between one and three health behaviour outcomes.
“Five of the six studies assessed between one and three outcomes in this category (Brown 2001; Glasgow 2004; Kinmonth 1998; Krones 2008; Loh 2007)”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Brown 2001
In Brown 2001, there was no difference in frequency of response for the seven items comprising the information needs scale.
“There was no difference in frequency of response for the seven items comprising the information needs scale.”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Brown 2001
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Interventions for providers to promote a patient-centred approach in clinical consultations
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Self-citation
- Authors
- Brown, R. F., Butow, P. N., Dunn, S. M., & Tattersall, M. H. N.
- Affiliations
- The University of Sydney (AU)
- ORCID
- Venue
- British Journal of Cancer
- Published
- 2001-10-30
- Volume
- 85
- Issue
- 9
- Pages
- 1273-1279
- ISSN
- 0007-0920 (ISSN-L)
- 1532-1827
- PMC
- PMC2375236
- OpenAlex
- W2068800072
- Cited by
- 309
- References
- 24
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 8 · 2023: 11 · 2022: 9 · 2021: 10 · 2020: 13 · 2019: 15 · 2018: 13 · 2017: 13 · 2016: 17 · 2015: 13 · 2014: 12 · 2013: 14 · 2012: 21
- FWCI
- 22.92
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- British Journal of Cancer (publishedVersion, cc-by-nc-sa)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Medical Research Council
- National Health and Medical Research Council
- Topics
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Keywords
- patient participation, cancer consultation, patient question asking, oncologist-patient communication, prognosis information, patient anxiety, information recall, consultation time, information needs, patient satisfaction, radiation oncology
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Anxiety, Communication, Female, Humans, Male, Medical Oncology, Middle Aged, Neoplasms, Patient Education as Topic, Patient Participation, Physician-Patient Relations, Prognosis, Referral and Consultation, Patient Satisfaction
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