Patients often report that they want more information from their healthcare providers or that the information they do receive does not address their needs. Generally, the amount of information given is small. People have differing needs for information, which also varies with the specific illness, but providing information is important as it helps patients recall, understand and follow treatment advice and be more satisfied. Clinicians may underestimate or undervalue the information needs of patients. They may also lack the skills to give information effectively. Training doctors and nurses probably helps, but another approach is to try to directly help patients ask questions in their consultations. This can be done by various methods such as question prompt sheets (which encourage patients to write down their questions) or coaching (when someone helps the patient to think of the questions they want to ask). This review evaluated studies of these types of interventions.
We identified 33 randomised controlled trials involving 8244 patients from six countries, mainly the USA, in a range of clinical settings. Most interventions, which included written materials (for example, question prompt sheets) and coaching sessions, were delivered in the waiting room immediately before the consultation. They were compared to dummy interventions or usual care. Health issues included primary care and family medicine, cancer, diabetes, heart problems, women's issues, peptic ulcer and mental illness.
We found small increases in question asking and patient satisfaction and a possible reduction in patient anxiety before and after consultations. We also found a possible reduction in patient knowledge and a possible small increase in consultation length. Both coaching and written materials produced similar effects on asking questions but coaching had a larger benefit in terms of patient satisfaction. Interventions immediately before the consultation led to a small increase in patient satisfaction whereas giving the intervention some time before did not. Interventions immediately before the consultation also resulted in small increases in consultation length, particularly when using written materials rather than coaching. Interventions some time before the consultation did not alter consultation time.
The interventions seem to help patients ask more questions in consultations, but do not have other clear benefits. Doctors and nurses need to continue to try to help their patients ask questions in consultations and question prompt sheets or coaching may help in some circumstances.