Associate Professor Alexandra Barratt1
Dr Heather Shepherd 1,2,
Professor Martin Tattersall1
Associate Professor Lyndal Trevena1
Professor Chris del Mar3
Professor Phyllis Butow1
Mrs Karen Carey4
Mr Kevin McGeechan1
Professor Vikki Entwistle5
Professor Ron Epstein6
1The University of Sydney
2 University of New South Wales
3 Bond University
4 Health Consumers Council, WA
5Social Dimensions of Health Institute, Scotland
6 University of Rochester
Project completion year
Applying clinical evidence to the care of individual patients is the last major stumbling block to the implementation of evidence-based practice. Tools to prompt question asking and patient involvement have previously been evaluated and their implementation into clinical practice has been limited. This project evaluated the effect of questions designed to prompt evidence-based practice from healthcare providers.
This project tested the effect of consumer questions to prompt clinicians to discuss and apply evidence to the care of an individual patient within a randomised trial using standardised patients and has developed an outcome measure to quantify frequency and nature of evidence-based, shared decision-making behaviours.
The project aims were to evaluate a brief consumer led intervention (‘Treatment Decision Questions‘) designed to increase discussion and use of evidence in general practice, and involve consumers more in their care.
The researchers evaluated a set of three questions proposed by consumer representative K. Carey-Hazell to prompt doctors to provide information that patients need to make an informed choice between treatment options in a cross-over randomised controlled trial. Four actors were trained to make unannounced Standardised Patient (SP) visits to primary care physicians (displaying symptoms of moderate depression) and oncologists (considering adjuvant drug therapy for early bowel cancer).
SPs were deployed in 46 consultations with 18 GPs and five oncologists. Two SPs visited each participating doctor five-24 weeks apart. One asked, and one did not ask, the questions (order allocated randomly). Consultations were audio-recorded, transcribed verbatim and analysed using OPTION (Elwyn 2003) to measure patient involvement. Communication about evidence (and its accuracy) was analysed using a tool the investigators developed: Assessing Communication about Evidence and Preferences (ACEP).
Key findings and main outcomes
Results of the randomised trial with standardised patients have shown that three questions from patients can improve patient involvement in decision-making and increase the quality of information patients receive about options and their benefits and harms. Total OPTION scores were calculated to give a score out of 100. OPTION scores were statistically significantly higher in intervention consultations. Mean scores were 38.32 and 25.27 for intervention and control arms respectively (p<0.001).
The researchers have developed a measure, The Assessing Communication about Evidence and Preferences (ACEP) measure, to capture these important elements of evidence-based practice. Analysis using this measure is in progress and further validation with real patient consultation is planned. The researchers believe that this is the first measure of communication about evidence that is applicable to a broad spectrum of healthcare consultation contexts.
The researchers have also developed a manual for use by the wider community.
This project enabled the researchers to complete 46 standardised patient visits to complete important proof of principle work.
Implications for policy and practice
The tools and manual developed as part of the project and intended for use by the wider community have the potential to impact on clinical practice by enabling consumers to engage more effectively with their health practitioners.
HL Shepherd, A Barratt, MHN Tattersall, LJ Trevena, PN Butow CB Del Mar, K McGeechan, K Carey Hazell. The use of Standardised Patients (SPs) to assess, audit and improve oncologists’ consultation skills. Australia & New Zealand Joint Scientific Meeting of Medical Oncology Group of Australia, Faculty of Radiation Oncology, New Zealand Society of Oncology and New Zealand Association of Cancer Specialists Clinical Oncological Society of Australia (COSA) 35th Annual Scientific Meeting, Sydney NSW November 2008
HL Shepherd, A Barratt, LJ Trevena, PN Butow, MHN Tattersall, RM Epstein, CB Del Mar, K McGeechan, V Entwistle, K Carey Hazell. Questions To Prompt Communication About Evidence. A Feasibility Study Using Standardised Patients. International Shared Decision Making Conference June 2009 Boston USA.
HL Shepherd, A Barratt, LJ Trevena, PN Butow, K McGeechan1, V Entwistle. The ACE coding scheme: development of a measure of to assess communication about evidence International Shared Decision Making Conference June 2009 Boston USA.
HL Shepherd, A Barratt, MHN Tattersall, LJ Trevena, PN Butow CB Del Mar, K McGeechan, K Carey Hazell. The use of Standardised Patients (SPs) to assess, audit and improve oncologists’ consultation skills. Australia & New Zealand Joint Scientific Meeting of Medical Oncology Group of Australia, Faculty of Radiation Oncology, New Zealand Society of Oncology and New Zealand Association of Cancer Specialists, August 2008, Christchurch, NZ.