THREE SIMPLE QUESTIONS TO IMPLEMENT EVIDENCE-BASED PRACTICE AND INCREASE PATIENT INVOLVEMENT

Purpose: To test a brief consumer-led intervention consisting of three generic “Consumer Questions” (See http://www.abc.net.au/rn/healthreport/stories/2006/features/questions.htm) designed to encourage doctors to discuss evidence related to treatment options with their patients. They are:  1. “What are my options?”  2. “What are the possible outcomes of those options?” 3. “How likely is each of the outcomes to occur?”  Our study aimed to evaluate the effects on (1) communication about evidence related to treatment options, and (2) patient involvement.

Method: We utilized a randomized design, set in family medicine practices in Sydney, Australia. Two professional actors were trained as Standardised Patients (SP) portraying two female roles with moderate depression.  The roles were similar in clinical presentation but one of the SPs was trained to ask the Consumer Questions (the other did not ask the intervention questions but could ask other questions). The SPs made an unannounced visit to each of 18 participating doctors 5-24 weeks apart (order allocated randomly).  Consultations were covertly audio-recorded. Doctors consented to the SP visits but did not know when they would occur, and were kept blind to the study purpose.  Audio-recordings were transcribed verbatim, and analysed using (1) the ACEPP (Assessment of Communication about Evidence and Patient Preferences) scale, specifically designed for this study to measure the quality of communication about clinical evidence and (2) the OPTION scale (Elwyn 2003) to measure patient involvement.  Two trained coders, kept blind to the study purpose, coded the transcripts.

Result: Scores in intervention consultations were significantly higher on both scales (Table).    

	Intervention score (mean)	Control score (mean)	Difference (mean)	P value
ACEPP Scale (range 0-40)	21.4	16.6	4.8	<0.001
OPTION Scale (range 0-100)	38.32	25.27	13.05	<0.001

Table: Effect of Consumer questions on communication about evidence and patient involvement            

Conclusion:

The questions increased communication about evidence and patient involvement.  The questions are a simple, inexpensive and sustainable consumer-led intervention which is widely applicable across health decisions, and does not require expensive development and updating processes.  Potential benefits are increased evidence-based practice, improved safety and quality of care, as well as better decision quality.