Results Summary

PCORI funded the Pilot Projects to explore how to conduct and use patient-centered outcomes research in ways that can better serve patients and the healthcare community. Learn more.

Background

During office visits, doctors and patients often make decisions about medical treatment. They also make decisions about lifestyle changes that patients need to make, such as in the areas of diet and exercise. It’s important that the patient remembers what they decided so that they are able to do what is needed at home. Doctors have some communication techniques that may help patients remember important decisions better.

Project Purpose

The research team wanted to see whether a patient’s gender, race, age, or education level affected how well they remembered a decision at an office visit. The research team also wanted to know whether certain communication techniques that doctors use made a difference in how well patients remembered a decision.

Methods

The research team audio-recorded 189 doctor’s visits with 101 patients who were recently diagnosed with heart disease or chronic kidney disease and had a big decision to make about treatment. The visits were with 11 doctors who treat heart disease and 8 doctors who treat kidney disease. The average age of patients was 57. More than half were women (54 percent), 72 percent were white, 20 percent were black, and 8 percent were another race.

The researchers interviewed the patients by telephone one week after their visit and asked them what they remembered. The researchers also asked patients about their satisfaction with the visit, their intention to follow the doctor’s recommendations, and their ability to manage their own care.

The researchers compared what the patients remembered about the decisions made at their visit with the recording of the visit. They looked at how well the patients remembered what was decided.

The researchers also counted how often doctors used specific communication techniques with patients during the visits. For example, doctors might use teach back, a method in which doctors ask patients to explain the decision in their own words.

The researchers ran statistical tests to see whether anything about the patients or the ways doctors communicated predicted how well patients would remember their visit.

Findings

Most patients remembered what they decided in the office visit.

None of patient age, gender, and race/ethnicity, nor doctor specialty, seemed to have any effect on whether patients remembered decisions after doctors’ appointments.

Patients who had higher levels of education remembered more about their visits. People with a college degree remembered 65 percent of decisions. People with less than a high school degree remembered 38 percent of decisions. For patients with lower education, the more things they had to remember from a visit, the less likely they were to remember very many of them.

All patients were less likely to remember decisions when doctors spoke more than the patients did during the visit. Doctors did not often use the different communication techniques with patients for which the researchers were looking.

Limitations

The number of people in the study was small. Results might have been different if more people had participated. Each researcher used their own judgment to determine what decisions were made in each doctor’s visit that they listened to and whether the doctor used specific communication techniques. Results might be different if other researchers had made these determinations.

Conclusions

To improve the patient’s ability to remember decisions, doctors should encourage patients to talk more. Doctors and patients might also limit the number of decisions being made during an office visit. Doctors may also want to keep in mind how much education a patient has, as this may link with their ability to recall decisions.

Sharing the Results

The researchers shared the results at conferences and lectures. Attendees included doctors, other healthcare professionals, patients, and researchers. They also wrote articles for journals.

More to Explore...

Dissemination Activities

Through limited competition, PCORI awarded 25 of the 50 Pilot Projects up to $50,000 to support dissemination and implementation of their activities and findings through the PCORI Pilot Project Learning Network (PPPLN) funding. The deliverables listed below are a result of convenings and conferences supported by this funding, whose efforts align with the PCORI strategic goal of disseminating information and encouraging adoption of PCORI-funded research results.

Period: September 2015 to December 2015
Budget: $49,993

Presentations

"Lack of an association between patient recall of treatment decisions, and patient activation and self-report of communication quality" and "Communicative processes in medical decision making and patient recall in specialty care: physician centered communication predominates" by M. Barton Laws at International Conference on Communication in Healthcare (ICCH) Conference on October 25th-28th, 2015 in New Orleans

"'The Talking Cure': A special event for patients and heath care providers on making clinical communication more effective"
Brown University in 2016

Project Information

Ira B. Wilson, MD
Brown University
$642,462
Methods for Analysis of Decision-Related Communication in Outpatient Care

Key Dates

June 2012
December 2014
2012
2014

Study Registration Information

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Last updated: March 4, 2022