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