The elicitation and management of multiple health concerns in GP consultations

Talk Code: 
1C.5
Presenter: 
Christopher Elsey
Co-authors: 
Ms. Catherine J. Woods, Ms. Libby Gennery, Dr. Beth Stewart, Dr. Rachael Summers, Prof. Paul Little, Prof. Michael Moore, Prof. Paul Drew, Dr. Rebecca Barnes, Dr. Fiona Stevenson, Prof. Carolyn Chew Graham, Dr. Geraldine M. Leydon
Author institutions: 
Primary Care and Population Sciences, University of Southampton, Faculty of Health Sciences, University of Southampton, Department of Social Sciences, Loughborough University, School for Social and Community Medicine, Bristol University, UCL Priment Clinical Trials Unit, UCL, Primary Care and Health Sciences, Keele University

Problem

Whilst patients often attend GP consultations with multiple concerns, they may not raise all of these during the consultation and even when they do, some concerns may be left unaddressed. Unmet concerns may arise out of misunderstandings between what GPs perceive as the patient’s “main problem” and patients’ potentially unvoiced other (multiple) concerns. Also the order in which patients present concerns does not necessarily relate to their importance and the patient may raise concerns related to significant problems late in the time-limited consultation. This can leave unaddressed symptoms to worsen, add to unnecessary patient anxiety, lead to poor health outcomes (such as dissatisfaction with the visit, treatment non-adherence) and result in additional costly attendances.

The secondary analysis reported builds on initial findings from an intervention study (Elicitation of Patient Concerns, EPaC) that found it was feasible to train GPs in the early elicitation of concerns. The aim of the current study is to understand interactionally how GPs and their patients manage consultations with more than one medical concern, using videos recorded from all parts of the original randomised controlled trial (RCT).

 

Approach

The data (195 video recordings and transcripts of consultations) were analysed using the methods of conversation analysis (CA), a micro-analytic, qualitative method that uses video and audio recordings of real-time interactions to understand how communication works in practice. This methodology facilitates our understanding of healthcare communication practices and findings from this type of research have been successfully turned into training programmes for health care professionals in a range of medical settings.

Findings

Using CA we aim to:

A. Identify how and where in the consultation GPs solicit for additional patient concerns, including the result of their solicitations

B. Identify how patients formulate/initiate their additional concerns, including how GPs respond to them

C. Identify key practices that enhance and inhibit the management of patients multiple concerns

Analysis is on-going and findings will be available for presentation for the first time at the conference. The talk will identify key communication practices that are likely to optimise the effective management of complex consultations with multiple patient concerns.

 

Consequences

The EPaC study indicated that an intervention involving early solicitation of concerns would support some GPs to clarify patient concerns. Further quantitative coding and CA work will provide in-depth and novel insights in to particular GP-patient communication practices and their consequences on the consultation. This will help identify strategies which may facilitate effective management of multiple patient concerns within time-limited GP consultations. Using these video recorded materials the study team will then develop and test a training module for medical professionals and medical students on the management of patients with multiple concerns.

Submitted by: 
Christopher Elsey
Funding acknowledgement: 
The team would like to thank the School for Primary Care Research (SPCR) for funding this research and the GPs and patients who participated and permitted their video recorded consultation to be used.