A Pilot Study to Improve Patient-Doctor Communication
Condition: Chronic Disease; Hypertension; Hyperlipidemia; Diabetes Mellitus; Osteoarthritis; COPD; Cardiovascular Disease
MeSH terms: Cardiovascular Diseases; Hyperlipidemias; Chronic Disease
Study type: Interventional

Summary: 
      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.
    

Detailed description: 
      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.
    

Intervention name(s): Patient Primer Tool
Intervention type(s): Behavioral
Intervention description(s): 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.
Other intervention name(s): Patient Activation Tool
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: Patient Satisfaction; Patient Doctor Communication; Shared Decision Making; Patient Activation