SHP 08-152 – HSR&D Study
Career Development Projects
Improving Self-Management Through Facilitated Patient Physician Communication
Richard M. Frankel PhD
Richard L. Roudebush VA Medical Center, Indianapolis, IN
May 2008 -
Low health literacy and variable communication skills of physicians are serious barriers to self-management in adults with chronic illness. Our pilot study was designed to test the feasibility of two interventions: one focused on improving the ability of veterans with poor health literacy and/or self management skills to communicate their questions and concerns about chronic disease to their physician; the other to help physicians communicate more effectively with veterans who have difficulty in self management. This proposal is aligned with continuing efforts in the VA to increase patients' level of involvement in their care and overcome barriers to self management. This is the first study of its kind in the VA to intervene with both members of the physician-patient dyad in an attempt to improve care processes and outcomes related to self-management.
This project has four specific aims:
1.Test the feasibility of assessing and enrolling veterans with poor health literacy and/or challenges in self management and physicians with variable communication skills to participate in the study;
2.Test the feasibility of a one-on-one consultation between study veterans and a health educator focusing on improved communication about self management;
3.Simultaneously, test the feasibility of a physician-based communication enhancement intervention;
4.Use the pilot data to develop an IIR that will test the effectiveness of the interventions in a randomized clinical trial.
This is a pre-implementation study of two separate interventions that have been shown to be effective but have not been studied in combination. The study will be conducted in the primary care clinics of the Richard L. Roudebush VA Medical Center. The participants are five physicians with varying communication skills and 15 patients with chronic disease who have low health literacy or evidence of difficulties in self-management. Study methods include health literacy screening, self-management screening, video-taping of patient-physician interaction before and after the interventions, follow-up interviews regarding the barriers and facilitators of the interventions, and analysis of Time 1 and Time 2 differences in veterans' expression, and physicians' encouragement, of communication about self-management.
The study has undergone several changes since its inception including: a shift in entry criteria to include challenges in self management as well as low literacy, recruiting of study physicians with variable, rather than just poor communication skills, and adjustments to the interventions based on our experience. Approximately 200 patients were approached using a variety of recruitment methods and 9 were recruited and videotaped at least once (2 Time 2 visits are pending). We found that coaching physicians and patients in parallel skills, especially agenda setting (Habit 1) and comprehension of medical instructions (Habit 4) resulted in measurable time 2 changes. We conclude that a larger trial is both feasible and desirable.
The proposed study directly addresses a stated need to enhance self-management skills of veterans with chronic diseases. The interventions we tested could have a direct effect on veterans by reducing communication barriers associated with poor self-management. The results from this pilot study will lead to the development of a 3 arm randomized controlled trial (physician intervention only, patient intervention only, and both interventions together) to improve self-management through facilitated communication.
None at this time.
Communication -- doctor-patient