Ruth Slater, Gillian Boucher and Rebecca Galbraith of Quintiles Medical Communications explain why how patients who actively seek out medical information achieve better healthcare outcomes
There is no doubt that, in recent years, people have become more informed about their medical conditions, and many patients feel a greater sense of ownership of their own health.
The closing divide between knowledge levels of healthcare professionals (HCP) and their patients is changing the dynamic of the doctor–patient relationship.
Good communication therefore plays a key role in ensuring that patients receive the most appropriate treatment plan for their individual circumstances and that HCPs deliver it successfully.
The general public now has greater access to the latest medical information, aided by the rise in the coverage of scientific and medical stories in the media and the virtual explosion of health-related information available on the Internet.
There are numerous online blogs, communities and social networks for almost every medical condition, providing peer-to-peer support and opportunities to share personal experiences.
Many sites traditionally targeted at HCPs, such as the BMJ, Cochrane Library, National Institutes of Health and the Mayo Clinic, have created public-facing portals.
There has also been a noticeable rise in the presence of patient groups working to increase disease awareness at both the public and political level.
As a result, patients are taking a much more consumerist approach to their health, with a growing expectation of control, choice and value.
Information versus misinformation
Physicians, however, have shown a more cautious response to non-HCP information sources.
In 2011, Quintiles published The New Health Report, a survey exploring the changing face of today’s healthcare provision.
The US-based survey included 400 primary care physicians and 1,000 adults with a chronic health condition, currently receiving treatment.
Three-quarters of patients participating in The New Health Report survey believed that they were very well educated about their condition; the most cited sources of information were either their physician or the Internet.
However, physicians were divided over the quality of information their patients accessed, with 36% indicating that they believed that their patients come to them with more misinformation than they did five years ago, compared with 33% believing that their patients often have less misinformation.
The BMJ has highlighted this significant variability in the overall quality of information available online, emphasizing the importance of people discussing the information source with their HCP.
In a poll of GPs, 88% of respondents said that patients brought health information to the consultation, and 60% said that they recommend the Internet as a source of information.
However, the survey also found that less than half provided guidance on specific sites for their patients.
The growing patient voice is having a noticeable impact on healthcare policy making.
In the UK, healthcare policymakers are placing an increasing focus on the patient in the design, planning, delivery and evaluation of healthcare provision.
Patient choice has become a central theme, through guidelines such as “Consent guidance: patients and doctors making decisions together”, while organizations such as the National Collaborating Centre for Primary Care (NCCPC) highlight the need for involving the patient in decisions about their medication to support adherence.
With the rapid changes to the knowledge levels and healthcare expectations of the average patient, it is not surprising that the dynamic of the patient–physician relationship is changing.
Physicians and other HCPs are increasingly embracing the importance of effective patient communications for its proven impact on achieving desired clinical outcomes, and ‘communications skills training’ is being included in the curriculum of medical degree courses and continuing professional development plans.
Assessments have demonstrated that a patient who is well informed and who feels more involved in their healthcare decision making is more likely to be engaged with, and adherent with, their medication.
In the New Health Report, 65% of physicians felt that patients who more actively seek out information about their medical conditions achieve better healthcare outcomes.
This is confirmed by a range of research surveys conducted by Quintiles with members of the MediGuard patient community.
In a survey of over 600 patients across 10 medical conditions, 88% of respondents indicated that receiving additional product information motivates them to take their medication as prescribed, and a similar percentage agreed that it makes them more likely to refill prescriptions.
Central to effective communications is the need for two-way dialogue.
Key techniques most frequently highlighted in HCP guidelines include:
1. Adopting a flexible consultative approachthat enables all patients to participate in the decision-making process, with shared agreement on treatment choices.
2. Finding the right language; complicated processes should always include a patient-friendly explanation, be communicated through pictures, diagrams and symbols wherever possible, and be accompanied by written materials.
3. Ensuring correct understanding of treatment administration – using techniques of repetition and recall, creating a communications dynamic where the patient feels enabled to ask questions.
4. Understanding potential issues and effectively managing expectations– gaining a better understanding of the patient experience of their medical condition, in the context of their lifestyle, preferences and beliefs. Openly discussing the pros and cons of proposed treatment plans and medications.
5. Providing motivation and encouragement – employing advanced communications techniques such as motivational interviewing.
The patient also has a role to play – for example, providing all the information needed to take an adequate history and make an accurate diagnosis, and being ready to ask questions to improve their understanding.
The Ask Me 3 (AM3) campaign launched by the National Patient Safety Foundation encourages patients to ask three simple questions to help clarify information about their treatment.
Similarly, the NHS Choices website encourages patients to prepare for their appointments by providing generic questions that they can use and offering hints and tips about how to get the most from their conversation with their HCP.
The provision of practical tools including discussion guides and visual symptom tracking tools can help patients to get the most from their consultation.
Despite this increasing focus on effective communications, our interaction with the MediGuard community indicates that many people still do not always feel that they are receiving adequate information; in the previous survey, 40% of respondents felt that they received too little information from their physician, rising to up to 50% in chronic conditions such as asthma, chronic obstructive pulmonary disease and multiple sclerosis.
It should also be recognized that not all patients want the same level of empowerment or control over healthcare decision-making.
A UK study of 190 patients and physicians in primary care found that 39% of patients wanted their GP to share the treatment decision; however, 45% still wanted the physician to be the main (28%) or only (17%) decision maker.
Similarly, a US study of older adults with chronic pain indicates that older patients are not as comfortable with the movement towards joint decision-making.
This distinction is not always picked up by physicians; the Cox study showed that the participating GPs were poor at realizing which patients want to be included in decision-making, only correctly identifying 32% of cases.
Best practice from clinical research
Many effective communications approaches can be adopted from the interaction between investigators and patients participating in a clinical study.
As clinical trial recruitment is notoriously difficult, substantial efforts are used to develop effective strategies and tools to support a positive and informed conversation between investigator and patient. (For more on clinical trials, see Social media: A tool for clinical trial recruitment?and How Quick Response codes can help pharma engage with patients.)
The necessity for two-way dialogue has long been recognized, particularly the need for patients to fully understand the details of the clinical trial and the formal process by which they confirm participation, the Informed Consent.
To effectively participate in a study, patients must be aware of their responsibility to attend clinic assessments, take the investigational product as instructed, and report any adverse events.
Many studies are conducted in several countries, among heterogeneous groups of patients with wide variations in health literacy, so communications materials must be easy to translate.
Typically, well-informed patient groups demand additional information on the trial, the investigational agent, and its mechanism of action, and providing supplementary information can encourage a more effective dialogue.
All clinical trial recruitment materials are written to strict guidelines, and undergo rigorous review by the appropriate ethics committee.
The learnings gained from communication during a clinical trial can be summarized in three key points:
1. Often the most simple of communications tools, such as discussion guides, are the most effective.
2. Even with a range of tools available, the communications skills of the investigator or site staff remain essential, adapting their communications approach so that the language they use, and tools they apply, are appropriate to each individual patient.
3. Ensuring that communications tools have been reviewed at a patient level will make sure that they are relevant to the participants’ information needs.
Supporting healthcare professionals in the digital age
Many of these communications techniques require a significant investment of HCP time and attention, time that many physicians do not have during the average consultation.
Consequently, in recent years, there has been significant focus on the use of new technologies, such as the Internet and mobile phones, to supplement traditional physician appointments.
A systematic review of patient Web portals and online disease management support programs targeted at people with diabetes demonstrated a number of important benefits, particularly in improving standards of care and clinical outcomes.
The availability of Web portals also enhanced patient–HCP communication, expanded access to information and ultimately increased patients’ overall satisfaction with care.
Cochrane assessments of adherence interventions indicate that the most effective long-term approach requires a combination of activities and interventions, with multiple communications touch points.
However, historically assessing the impact of communications interventions on standards of care, particularly behaviors around adherence, has been challenging.
It is therefore essential that any support programs incorporate outcomes data collection and ongoing feedback loops on each intervention from the very start.
Quintiles has designed and delivered a range of multi-channel programs to support HCPs and engage, educate and support patients to better manage their condition and get the best from their treatments.
Key to the success of these activities is a comprehensive understanding of the patients' diverse psychological and behavioral motivations around disease and medications, combined with smart targeting of the communications channels used.
Content is targeted, based on patient profiling to ensure maximum relevance to the patient’s motivations and support needs.
An evidence-based approach to program design has ensured the most effective mix of content and interactions to create measurable improvements in patient outcomes and quality of life. (For more on evidence-based approaches, see Mal's Musings: Evidence-based medicine—The end of pharma marketers?and How to build value through comparative effectiveness research.)
Often these support programs are sponsored by the pharmaceutical companies providing the medications that the patient is using for their particular condition.
This is part of a growing willingness for closer working partnerships among governments, healthcare providers and the industry in order to offer greater value to the patient.
It is clear that HCPs have been taking time to focus on the communications dynamic with their patients; however, numerous assessments and patient surveys indicate that there is still room for improvement.
Worryingly, even recent studies have indicated that some HCPs still do not always discuss key information, such as directions for use and potential side effects, or provide takeaway materials to ensure that their patients are able to remember important instructions.
There is an opportunity and a need to assist HCPs with patient education and engagement to help to encourage optimal treatment outcomes and to measure success.
Complex multi-channel communications play an important role in enhancing healthcare provision, but our experience with clinical studies shows that the simplest tools can often be the most effective.
All communications tool development must be based on strong patient understanding and insight; patients often want simple, visual tools that clearly explain what is involved in their treatment.
Members of the MediGuard patient community indicate a high preference for the value of clear information on their disease, how their medication works, and its effectiveness, side effects and dosing.
Ultimately, effective communication is simply about talking and listening, with HCPs seeking greater interaction with their patients.
Communications support tools, whether simple or complex, need to be a catalyst for helping patients to become active participants in their medical consultation and to work together with their physician to get the best from their treatment.
For everything patient-related, join the sector’s other key players at Patient Adherence, Communication and Engagement (PACE) USAon October 24-25 in Philadelphia. Download the full PACE agenda and speaker line-up here. Want to know more? Contact email@example.com.
To read our Patients’ Week stories from 2010, see Patients’ Week 2010.
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