title: Encouraging Patient-Centered Care by Including Quality-of-Life Questions on Pre-Encounter Forms.
abstract: Patient participation in clinical decision making improves outcomes, including quality of life (QOL), but the typical problem-oriented approach may impede consideration of functional goals. We wondered if patients could encourage primary care physicians to pay attention to their QOL goals by writing them on pre-encounter forms.
  
  
  
  We conducted a randomized controlled trial comparing the impact of 2 different pre-visit questionnaires on the content of patient-physician encounters in a family medicine practice at an academic medical center. Using investigator-blinded block randomization, we arranged for 8 faculty and 8 resident physicians to participate in 2 intervention and 2 control videotaped encounters each for a total of 64 encounters. The intervention questionnaire included questions about QOL goals and concerns, while the control questionnaire asked about symptoms. Videotapes were reviewed to determine whether the patients' QOL goals were mentioned and whether they were used in decision making. We also scored encounters using Modified Flanders Interaction Analysis, which assesses and codifies patient and physician communication, and the Modified Carkhuff-Truax Scale, which measures empathy, attending, congruence, and positive regard.
  
  
  
  Patients were able to record QOL goals and concerns, but QOL issues were mentioned in only 2 of the 64 encounters, once by a patient and once by a physician. In neither case was this information used in decision making. More empathy was expressed by physicians during control encounters (P = .03).
  
  
  
  Patients were able to articulate their QOL goals on paper, but that did not prime them or their physicians to alter the process or content of the clinical encounters. In fact, providing QOL information was associated with reduced physician empathy.
authors.affiliation: University of Oklahoma College of Medicine, Oklahoma City, Oklahoma becky-purkaple@ouhsc.edu.
authors.forename: Becky A
authors.initials: BA
authors.lastname: Purkaple
authors.affiliation: Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
authors.forename: James W
authors.initials: JW
authors.lastname: Mold
authors.affiliation: Department of Biostatistics and Epidemiology, University of Oklahoma, Oklahoma City, Oklahoma.
authors.forename: Sixia
authors.initials: S
authors.lastname: Chen
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000066491:Clinical Decision-Making; D003142:Communication; D004645:Empathy; D005260:Female; D006040:Goals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009825:Oklahoma; D010358:Patient Participation; D018802:Patient-Centered Care / Q000592:standards*; D010817:Physician-Patient Relations; D010821:Physicians, Family; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014741:Video Recording
keywords: family medicine; general practice; goal-directed care; patient-centered care; quality of life