Edinburgh Napier University

  Background
Holistic needs assessment (HNA) helps patients articulate their wider needs during consultation. The study objective was to establish how HNA changes consultation dynamics. It is hypothesised that HNA will support greater patient participation, facilitate shared decision-making and increase self-efficacy.

Methods
Randomised controlled trial. Three outpatient oncology clinics in West of Scotland recruited patients with neck or colorectal cancer who had received treatment. Control group entailed routine consultation. Intervention group patients completed HNA before consultation then the clinician used it to guide consultation. All consultations were audiorecorded. Patient participation was determined by MEDICODE: dialogue ratio (DR) and preponderance of initiative (PI) within consultation. Shared decision-making with CollaboRATE; self-efficacy with Lorig’s measure.

Results
Fifty-five people were randomised to intervention, 61 to control. More patient concerns were discussed in the intervention group (8.9) than control (6,6) (p=0.00). Emotional concerns were discussed more frequently (respectively 27,1% and 19,4%, p=0.01), and clinicians expressed more support (14,4% compared to 10,2%, p=0.08) in intervention group.

Discussion was initiated mainly by clinician in both groups (76,4%), and participation tended to monologue in both (54.1%). However, patient initiative was significantly higher in experimental group when discussing control of problems (respectively 40,0% and 24,1%, p=0.03). Dialogue was also when discussing symptoms (respectively 75,1% and 63,6%, p=0.01). Self-efficacy was higher in the experimental group (mean Lorig: 8.3 v 7.6 p=0.093), as was CollaboRATE (25.1 v 23.4, p=0.121), though neither was statistically significant.

Discussion
These preliminary results showed HNA changed the dynamics of the clinical consultation. Patients discussed more concerns in general, and more emotional concerns in particular. Patient participation increased when discussing symptom control, suggesting patients would self-manage better. This is supported by the higher self-reported sense of collaboration and higher self-efficacy levels in the experimental group. These trends may become statistically significant when the study reaches sufficient power. Regardless, current results show that incorporating mechanisms designed to support discussion of personal needs changes the focus of the consultation, and that these changes enhance patient self-management. Strengths and weaknesses will be discussed, along with a more nuanced analysis of the impact of HNA on consultation style.