Patient participation in the consultation process: a structured review of intervention strategies.
OBJECTIVE
To describe the range and effectiveness of intervention strategies designed to enhance patient participation in the consultation process.


METHODS
A systematic review of published literature (1976-2004) was undertaken. Controlled trials in English were included. Data regarding study design, intervention characteristics, patient populations and study results were extracted.


RESULTS
One hundred and forty-six articles describing 137 trials were reviewed. A pragmatic categorisation of intervention strategies and study outcomes supported data synthesis. Patient-targeted coaching and educational materials, and provider-targeted communication skills training have a substantial impact on communication. Information feedback to providers from patient-reported outcome measures (PROMs) benefits provider diagnosis and management of patient conditions. Communication and provider diagnosis and management benefit most from the reviewed interventions. Although patient satisfaction and health status were two of the most frequently measured outcomes, overall, the interventions appeared to have less impact on patient self-efficacy, attitudes and behaviours, patient satisfaction, health status and resource use.


CONCLUSIONS
Evidence is insufficient to strongly advocate one approach to enhancing patient participation in the consultation process. More rigorous research design with clearly specified intervention strategies and appropriately defined outcomes assessed over both the short and long term is required.


CONCLUSIONS
Although limited and inconclusive, the most extensive and most encouraging evidence to enhance patient participation in the consultation process is available for three patient-targeted intervention strategies (coaching, educational materials and PROMs feedback to providers) and one provider-targeted intervention strategy (communication skills training).
Haywood
Kirstie
K
Royal College of Nursing Institute, Radcliffe Infirmary, Woodstock Road, Oxford OX2 6HE, UK. kirstie.haywood@rcn.org.uk
Marshall
Susan
S
Fitzpatrick
Ray
R
D002983:Clinical Competence; D003142:Communication; D018849:Controlled Clinical Trials as Topic / Q000592:standards; D003299:Cooperative Behavior; D019317:Evidence-Based Medicine; D030141:Feedback, Psychological; D006040:Goals; D007722:Health Knowledge, Attitudes, Practice; D006304:Health Status; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D010347:Patient Care Planning; D010353:Patient Education as Topic; D010358:Patient Participation / Q000379:methods* / Q000523:psychology; D011369:Professional-Patient Relations; D012017:Referral and Consultation / Q000458:organization & administration*; D012107:Research Design; D020377:Self Efficacy