The Patient's First Point of Contact

Study Overview
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Brief Summary
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The overall objective of this observational study is to investigate practices of communication and decision-making during nurses' initial assessment of patients' health problems in primary care, examine working mechanisms in good practices and develop feasible solutions. The specific aims are: To investigate patients' expectations and experiences with the communication and decision-making during their first contact with a registered nurse (RN) in primary care. To investigate patient-RN communication on the level of patient involvement. To investigate RNs' actual communication, assessments and decision-making, value conflicts and the challenges and strategies they use in prioritizing. To analyse the underlying working mechanisms of good communication practices. To develop methodologies for facilitating efficient processes in assessing, managing, and prioritizing patients in primary care for RNs. Project PINPOINT aims for a prospective multicenter study, using various methods for data collection and analysis.

Official Title
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The Patient's First Point of Contact (PINPOINT) - Protocol of a Prospective Multicentre Study of Communication and Decision-making During Patient Assessments by Primary Care Practice Nurses

Conditions
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Nurse-Patient Relations

Intervention / Treatment
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* Other: Observations to investigate the current practices of communication and decision-making during Nurse-patient consultations


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Registered Nurses at primary care centres and patients seeking primary care for a new health concern or a new episode of a problem Exclusion Criteria: Patients visiting the primary care nurse with a chronic or continuous health problem

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Other: Observations to investigate the current practices of communication and decision-making during Nurse-patient consultations|No intervention|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient-reported expectations and experiences of the communication during consultations | Data will be gathered with the following questionaries: QUOTE-COMM, QUality Of care Through the patients' Eyes, and The COOP/WONCA, measuring functional health status. The QUOTE-COMM is used to gather patient reported data on expectations and experiences of communication aspects during consultations. At baseline the importance of (expectations) of various communication aspects are rated, and after experiences from the consultation, to evaluate to what extent RNs met patients' expectation. The COOP/WONCA is used at baseline to measure health status. | At baseline (day 1), after visit (day 1) and at 2-4 weeks | 
| Communication processes and patient involvement as observed during consultations | Data will be gathered with audio recordings during real time consulltations. The observations with audio recordings will be coded with OPTION5, observing patient involvement in decision making, and the Verona Coding definition of emotional sequences, VR-CoDES. The OPTION5 scale is a reliable and valid instrument for investigating patient involvement in decision making. The Verona Coding Definitions on Emotional Sequences (VR-CoDES) is a reliable and valid instrument for coding of sequences of communication involving negative emotions, e.g., elicitations and expressions of patient cues and concerns, and RNs responses. | Day 1. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Assessment and decision-making processes, and related priorities and value conflicts - from observations and RN experiences | Data will be gathered with observations with audio recordings and interviews, and analysed with qualitative methods to gain insights on assessments and decision-making processes during consultations, and related priorities and value conflicts | Through study completion, an average of 1 year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Communication, Decision-making, Nurse, Primary care