The impact of a video intervention to improve patient participation in the hospital outpatient consultation
The aim of this study was to develop a video intervention and to determine whether it could be successful in increasing patient participation in medical interviews. The efficacy of the intervention was evaluated by examining the effects of the video on the process of communication and on patient outcomes. The secondary aims of the study were to investigate the role of individual patient differences and the doctor on the consultation. This study was experimental, with patients allocated to one of three groups, experimental, placebo control and control. The experimental group watched a video designed to improve their communication with the doctor, the placebo group saw a neutral video and the control group no video. All patients completed questionnaires assessing anxiety, health related cognitions and health status immediately prior to their consultation. The consultations were audiotaped and subsequently analysed using the Verbal Response Mode coding system (Stiles, 1992). Post-consultation, further questionnaires were completed to assess anxiety, satisfaction, perceived control over recovery and ability to communicate. Data from 206 participants were analysed. The results demonstrated that the video intervention did not result in significant increases in patient participation or improved outcomes. Individual patient differences accounted for a small proportion of the variance in patient participation and satisfaction. Significant differences were found in patient participation and satisfaction according to the doctor seen. Individual patient differences and the doctor seen predicted the patients' verbal contribution to the consultation and patient satisfaction. A significant interaction was found between the experimental group and doctor on the measure of patient satisfaction, in that experimental group patients of one doctor were more satisfied than controls. The findings suggested that targeting an intervention exclusively at patients was insufficient to produce improvements in participation and outcomes, except where circumstances within the consultation were favourable to patient participation. The evidence indicated that doctors play an influential role in the consultation and interventions may be more successful if directed at doctors and patients simultaneously.