A qualitative examination of patient experiences of dietetic consultations
There is considerable interest in healthcare research regarding communication skills (Ong, de Hoes, Hoos & Lammes, 1995) and some debate surrounding the effectiveness of a patient-centred approach to care (Mead & Bower, 2000). Understanding patient experiences of consultations can help indicate how consultations can be modified to improve effectiveness (Stewart & Browne, 1996). There is currently little research exploring patient experience of dietetic consultations. The aim of this project was to achieve a better understanding of patients’ experiences of dietetic consultations. Methods:
Nine patients who had undergone one or more consultations with a dietitian were invited to take part in individual interviews and a focus group to discuss their experience of the consultation. A topic guide was used to ensure that relevant information was collected by the researcher, who was a dietitian not involved in patient care, and the interviews and focus group were audio taped and transcribed. Transcripts of these interviews were analysed using the framework approach (Spencer, Ritchie, Lewis & Dillon, 2003; Ritchie & Lewis, 2003), a systematic approach to qualitative data analysis which comprised five distinct stages: familiarisation, development of thematic framework, indexing, charting and synthesising and mapping and interpretation. Ethical approval for the data collection was granted by the NHS Research Ethics Committee and the Ethics Committee of London Metropolitan University. Results:
Patient experiences of dietetic consultations were varied. Factors influencing the experiences were categorised into three categories, each with a series of sub categories: information and resources (accuracy/consistency, clarity, sufficiency, adaptation for patient, effectiveness); healthcare system (time, multi-disciplinary team involvement, access to dietitian, access to group/peer support) and support (communication, dietitian's manner, approach, motivation, empathy). Discussion:
Patients agreed that certain factors, such as good communication and rapport, receiving effective and reliable information and resources, and non-judgemental, regular support were important factors in creating a positive experience of their dietetic consultation. However, patients differed as to what constituted achievement of these factors. Patients would like dietitians to adopt a patient-centred approach insofar as it takes account of what they want from consultations and adapts to meet their individual requirements, even if these requirements are for a more prescriptive, biomedical approach. Conclusion:
This study examined the experiences of a small group of patients and found that even within this group, experiences of dietetic consultations varied widely. Whilst the specific findings of this study may not be not be generalisable to the experience of all patients, they show that the most important issue for patients is that their individual needs and circumstances are recognised by a dietitian during a consultation. Awareness of this is essential if dietitians are to function effectively as facilitators of behaviour change. References:
Ong, L.M., de Haes, J.C., Hoos, A.M. & Lammes, F.B. (1995) Doctor-patient communication: a review of the literature. Soc. Sci. Med. 40, 903–18.
Mead, N. & Bower, P. (2000) Patient-centredness: a conceptual framework and review of the empirical literature. Soc. Sci. Med. 51, 1087–1110.
Stewart, M. & Browne, J.B. (1996) Patient centredness in medicine. In Evidence Based Patient Choice. ed. T. Hope pp. 19–28. London: The King's Fund.
Spencer, L., Ritchie, J., Lewis, J. & Dillon, L. (2003) Quality in Qualitative Evaluation: A Framework for Assessing Research Evidence. London: Government Chief Social Researcher's Office.
Ritchie, J. & Lewis, J. (2003) Qualitative Research practice: A Guide for Social Science Students and Researchers. London: Sage.