How do patients engage with cancer information? An observational study of GP waiting rooms

Problem

It is routine practice to offer health information to the captive audience of patients in a GP waiting room. Yet little research has examined what patients do with that information. Studies to date focus on the impact of waiting spaces on mood (Clapton 2016). Maskell’s 2018 survey identified that patients find information unattractive or uninteresting. But little is currently known about how patients engage with health information in waiting rooms in practice. This study seeks to explore how information in waiting rooms is planned and managed, and what really happens while patients wait for appointments. We focus on cancer symptom information as a critical case through which to examine this phenomenon.

Approach

Sample – 16 practices with diverse demographics and building layouts across four UK regions. Data collection – 80 hours of observations in waiting rooms, 32 semi-structured interviews with staff, and a patient questionnaire. Observation sessions recorded all patient activities taking place in the waiting room seating area. Posters in the waiting room specified practice involvement in a research study but the observer role was not made known. Staff interviews focused on information provision strategies and resources, spatial layouts, and expectations about patient engagement with information. Findings from content analysis and thematic analysis of these data were used to develop a questionnaire investigating patients’ perceptions of engaging with information in waiting rooms. This will be distributed to 3,600 patients who had recently attended for consultations across the 16 practices.

Findings

Three key themes emerged. 1) Patient engagement with information varied widely: average waiting times varied and patient activities centred around mobile phone use, watching JX displays or screens for call-in, talking with companions or interacting with children. Variation in engagement was related to spatial layout, the pace of call-ins, and the choice of ‘distractions’ in the room. 2) Patient engagement and staff expectations about information use were mismatched. Observations did not support staff optimism about information utility. 3) For cancer symptom information, findings demonstrated barriers and facilitators related to uptake. Barriers included the focus of information displays on seasonal illnesses, practice protocols, and health issues directly linked to practice outcomes such as preventative screening. Facilitators included national cancer campaigns and targeted practice-level engagement by cancer charities.

Consequences

More innovative approaches to information provision are required to enable the effective use of waiting room space to deliver health messages.