Patient perceptions that limit a community-based intervention to promote participation

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Abstract

A workshop designed to teach seniors to communicate more effectively with their physicians and enhance patient participation in the consultation was held in a community centre. A grounded theory analysis of follow-up telephone interviews provided examples of effectiveness but also revealed six categories of barriers to changing the pattern of established communication, particularly over the short term.

Introduction

Shared decision-making requires good communication between doctor and patient and active patient participation. Most work has focussed on improving communication skills of doctors. However, sole reliance on the physician for the quality of communication in the consultation tends to perpetuate a paternalistic ‘doctor knows best’ approach to the relationship. Skills practice and modelling interventions to promote patient participation have been effective when associated with a specific visit to the doctor’s office [1], [2], [3]. They have not been reported outside the research context. Community-based interventions have the potential for greater dissemination, lower cost and are consistent with the patient empowerment movement. In partnership with a seniors’ interest group in North Vancouver, Canada, we explored the possibilities of enhancing patient participation through a community-based intervention. Seniors were the selected target because they make frequent visits to the doctor, are large consumers of health care and readily have the time to go to workshops.

Section snippets

Method

We put on workshops for seniors at a community centre in conjunction with a regular weekly ‘keep well’ programme. The seniors in this group came from a relatively affluent urban community and had a high socio-economic status (>60% with post secondary education). Participants were volunteer responders to posters advertising the workshops titled: “Talking with your doctor”. The workshops were about 2 h in duration, interactive and used a tested framework and booklet [4], [5] with modelling by

Results

The participants’ major reasons for attending the workshop were categorized as: to improve communication generally; reassurance about existing communication; and help for specific problems. The physician relationships they had with general practitioners were well established. Their experience of decision-making with their physician covered the spectrum of patient led, doctor-led and shared decision-making.

The participants’ examples of what was learned from the workshop fell into the following

Conclusions

The workshop was acceptable and resulted in some specific examples of behavioural change. It appeared to be limited in effectiveness by: (1) expressed satisfaction with existing relationships (low drive to change); (2) most barriers to communications, with the exception of the category of ‘memory’, were attributed to the doctor (outside of patient’s control); (3) importance of maintaining good rapport (any attempt by the patient to make a change may be perceived to put this at risk); and (4)

Acknowledgements

This work was funded by grants from the Vancouver Foundation and a Florence E Heighway Summer Research Award. Our community partners were The Lionsview Seniors’ Planning Society, and our special thanks go to Mary Segal and Sheila Jones for their advice, enthusiasm and public relations skills. We are grateful to Dr. Garry Grams for assistance with data analysis. Finally we thank Dr. Don Cegala for expert advice and permission to use his booklet, ‘Communicating with your doctor’.

References (5)

There are more references available in the full text version of this article.

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