INCREASING PATIENT CENTERED COMMUNICATION AND DECISION MAKING IN PRIMARY CARE OFFICE VISITS: COMPARATIVE EFFECTIVENESS OF A NOVEL MULTIDIMENSIONAL INTERVENTION WITH AN EXISTING PATIENT ACTIVATION INTERVENTION

Purpose:

Test the comparative effectiveness of two interventions designed to improve patient centered communication and decision-making in primary care. 

Method:

We conducted a cluster randomized pilot trial to compare “Open Communication” (OpenComm), “Ask 3 Questions” (Ask3), and usual care in a fully crossed 2x2 design. Four primary care clinics were randomized, one to each trial arm. The novel OpenComm intervention, co-developed with a group of clinician, patient stakeholders, and user-experience design consultants, consists of: (1) an animated-video to encourage open communication between patients and physicians; (2) a patient visit companion booklet to enable patients to delineate issues that matter the most to them and to review and record their next steps; and (3) the use of Standardized Patient Instructors to provide communication coaching for physicians. Ask3 is an evidence-based three-question prompt list, encouraging patients to ask about options, potential benefits and risks and their individual likelihood.

   We collected 300 post-visit surveys from patients served by 26 primary care physicians (75 unique patient visits/clinic, average 11.5 visits/physician). Outcome measures included the percentage of patient participants who gave the highest possible score on CollaboRATE, a validated 3-item patient engagement measure that captures patient perceptions of patient centeredness of communication and decision-making in a consultation.

   Descriptive analyses and logistic regression with cluster robust standard errors were used to analyze the data. Covariates included patient age, sex, race/ethnicity, and education.

Result:

The proportion of patients who gave the highest possible score on CollaboRATE was 74.3% in the OpenComm clinic, 72.0% in the Ask3 clinic, 74.3% in the OpenComm combined with Ask3 clinic, and 67.6% in the usual care clinic. Compared with visits in the OpenComm clinic, the odds ratios of giving the highest possible CollaboRATE score were 0.75 (s.e.=0.05, p<0.01), 0.58 (s.e.=0.12, p<0.01), and 0.52 (s.e.=.05, p<0.01) in the Ask3, OpenComm+Ask3, and usual care clinics, respectively.

Conclusion:

CollaboRATE scores were highest in the OpenComm arm, and higher than Ask3 alone, the combination of both approaches, or usual care. The multidimensional OpenComm approach offers a promising approach to improve patient centered communication and decision-making in primary care office visits.