Comparing Ways to Support Communication between Patients and Their Primary Care Providers

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What was the research about?

Patients work with their primary care providers, or PCPs, to make decisions about their care. This process can improve patient experiences and health outcomes. But patients may be nervous about asking questions or disagreeing with their PCPs. PCPs may also lack training in the best ways to involve patients in decision making.

In this study, the research team compared three approaches to improve how patients and their PCPs make decisions together: 

• In-person coaching. Before their visit, patients received a survey that asked what they wanted to talk about with their PCPs. They also received a video about preparing for their visit. PCPs received in-person training on involving patients in decision making.
• Mobile app coaching. Patients received the same survey and video as the in-person coaching group. PCPs received training videos and tips in a mobile app on involving patients in decision making.
• Ask Share Know Poster (ASK). Posters placed in exam rooms urged patients to ask their PCPs three specific questions during the visit.

What were the results?

After their appointments, patients in the three approaches didn’t differ in:

• How well they felt their PCP involved them in making decisions about their care
• Plans to follow their care plan

After three months, compared with patients receiving care at the in-person coaching clinics, patients receiving care at the mobile app coaching clinics:

• Had less confidence in managing their health
• Were less likely to recommend their PCP to others

Who was in the study?

The study included 4,852 adults receiving care from one of 114 PCPs. Of patients, 78 percent were White, 12 percent were Asian, 2 percent were Black, 1 percent were Native Hawaiian or Pacific Islander, 2 percent were multiple races, and 5 percent did not report their race. The average age was 53, and 64 percent were women. All could communicate in English and had access to a patient portal, which is a secure website to view health records and test results, and send messages to PCPs.

What did the research team do?

The research team worked with PCPs at 21 primary care clinics. The team assigned clinics by chance to use one of the three approaches to improve patients’ communication with their PCPs.

The research team then surveyed patients about how well their PCPs explained health problems and treatment options. The team also asked about how much PCPs involved patients in decisions about their care and care plan. Patients completed surveys within seven days of their visit and again three months later.

Patients and PCPs from the clinics helped design the study.

What were the limits of the study?

The survey questions may not have worked well enough to detect differences across approaches.

Future research could use improved surveys to look at patients’ experiences and engagement with decision making.

How can people use the results?

Clinics can use these results when considering how to improve communication between PCPs and patients.

Objective

To compare the effectiveness of three approaches for improving communication between patients and primary care providers (PCPs) in improving patient-reported outcomes and shared decision making

This cluster randomized controlled trial compared the effectiveness of three communication interventions for patients and their PCPs in improving patient-reported outcomes and shared decision making. Shared decision making is a process in which patients work with their clinicians to select tests and treatments based on what is most important to patients.

Researchers recruited PCPs at 21 primary care clinics in three health systems and randomly assigned clinics to one of three interventions:

• In-person coaching. Patients received a pre-visit survey in their patient portal about what they wanted to discuss with their PCP during their visit and a coaching video on how to prepare. PCPs received in-person coaching on how to best address patients’ needs.
• Mobile app coaching. Patients received the same pre-visit survey and coaching video as the in-person coaching intervention. PCPs used a mobile app to access coaching videos on how to best address patients’ needs.
• Ask Share Know (ASK) poster. Researchers placed posters in exam rooms encouraging patients to ask their PCPs three specific questions during their visit to facilitate shared decision making.

The study included 4,852 adults receiving care from one of 114 PCPs. Of these patients, 78% were White, 12% were Asian, 2% were Black, 1% were Native Hawaiian or Pacific Islander, 2% were multiple races, and 5% did not report their race. The average age was 53, and 64% were women. All could communicate in English and had an activated patient portal.

Researchers surveyed patients within seven days of their visit to assess how well they communicated with their PCP and understood their instructions. Patients completed surveys again three months later assessing how well they followed their care plan.

Patients and PCPs at study clinics helped design the study.

Results

The three interventions did not differ significantly in patients’ assessment of their experience with the communication or shared decision making that occurred during their appointment.

After three months, compared with patients receiving care from PCPs at clinics assigned to in-person coaching, patients receiving care at clinics assigned to mobile app coaching:

• Had less confidence managing their health (odds ratio [OR]=0.174; 95% confidence interval [CI]: -0.339, -0.009; p=0.039).
• Were less likely to recommend their PCP to others (OR=0.579; 95% CI: 0.342, 0.978; p=0.041).

The three interventions did not differ significantly in other study outcomes.

Limitations

Measures used to assess patients’ experience and engagement with decision making may not have been sensitive enough to detect differences in outcomes.

Conclusions and Relevance

In this study, interventions did not differ significantly in patients’ assessments of their experiences with engagement or shared decision making. However, patients receiving care from PCPs in the mobile app coaching intervention were less likely to recommend their physician to others than were patients in the in-person coaching intervention.

Future Research Needs

Future research could use more sensitive measures to capture patients’ experience and engagement with decision making.