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Table 5 Scores on the availability items (‘communicative behaviour’) during the simulated 15-minute consultations of GPs in intervention group (n=62) and control group (n=64)

From: Effectiveness of the ACA (Availability, Current issues and Anticipation) training programme on GP-patient communication in palliative care; a controlled trial

Availability items

Baseline

Follow-up

Effect(difference7or odds ratio8) (95%confidence interval)

P-value

POSITIVE

Intervention n=60

Control n=64

Intervention n=55

Control n=60

  

1. Taking time (3 GARs, 3–18)1

13.23 (2.35)

13.05 (2.15)

12.95 (2.63)

12.40 (2.42)

.21 (−1.03; 1.46) 7

.73

2. Allowing any subject to be discussed (2 GARs, 2–12)1

8.45 (1.60)

8.55 (1.67)

8.38 (1.63)

8.12 (1.69)

.31 (−.55; 1.17) 7

.47

3. Active listening

      

A. Open/Closed Questions Ratio2

.65 (1.00)

.73 (1.12)

.57 (.44)

.58 (.74)

.07 (−.37; .52) 7

.74

B. Affective utterances (RIAS):

      

1. Back-channel responses3

29.5 (11.4)

30.8 (11.5)

31.9 (8.7)

32.8 (12.6)

.31 (−3.10; 3.71) 7

.86

2. Shows approval (=approval +compliment)4

.49 (.79)

.33 (.53)

.52 (.91)

.58 (.89)

-.22 (−.64; .19) 7

.29

3. Verbal attention (= empathy + legitimizes + partnership)4

4.33 (2.87)

4.96 (3.53)

4.46 (3.35)

4.36 (2.79)

.81 (−.66; 2.27) 7

.28

4. Shows concern or worry4

.04 (.23)

.11 (.53)

.00 (.00)

.08 (.40)

-.004 (−.20; .19) 7

.96

5. Reassurance (e.g. reassures, encourages, shows optimism)4

1.24 (2.26)

.84 (1.32)

1.17 (1.69)

1.23 (1.53)

-.66 (−1.49; .17) 7

.12

6. Agreement (shows agreement or understanding)4

1.51 (1.61)

1.45 (2.09)

1.56 (1.49)

2.03 (2.44)

-.56 (−1.30; .17) 7

.13

7. Personal remarks, laughs4

4.25 (2.60)

5.50 (2.86)

4.03 (1.91)

5.17 (2.25)

.19 (−.97; 1.35) 7

.75

8. Silence5

12

17

34

33

1.55 (.43; 5.62) 8

.51

C. Task-focused utterances (RIAS):4

      

1. Check (paraphrase/checks for understanding)

4.68 (2.91)

6.84 (4.33)

5.53 (3.74)

5.24 (3.36)

2.60 (.92; 4.29) 7

.003

2. Gives orientation, instructions, introduction

2.72 (3.02)

3.25 (3.07)

3.13 (2.26)

3.08 (2.82)

.60 (−.80; 2.01) 7

.40

3. Bids for repetition

.30 (0.84)

.27 (1.13)

.16 (.37)

.18 (.51)

-.05 (−.44; .35) 7

.82

4. Asks for understanding

.06 (.23)

.06 (.23)

.04 (.22)

.01 (.10)

.02 (−.09; .12) 7

.72

5. Asks for opinion

1.43 (1.14)

1.49 (1.23)

1.37 (1.21)

1.31 (1.14)

.17 (−.40; .75) 7

.55

4. Facilitating behaviour

      

A. Facilitating behaviour (5 GARs, 5–30)1

22.15 (3.28)

21.92 (3.70)

22.29 (3.50)

21.17 (3.62)

.65 (−.99; 2.30) 7

.43

B. Meta-communication5

22

16

22

15

.98 (.29; 3.33) 8

.97

5. Shared decision making with regard to diagnosis and treatment plan

      

A. Shared Decision Making (3 GARs, 3–18)1

11.77 (2.22)

12.13 (2.58)

11.80 (2.36)

11.22 (2.31)

.88 (−.37; 2.14) 7

.17

B. Extent of shared decision making (Range per topic 1–4)6

2.14 (.54)

2.22 (.57)

2.23 (.56)

2.16 (.57)

.14 (−.16; .45) 7

.35

6. Accessibility 5

10

12

11

12

1.03 (.20; 5.34) 8

.97

NEGATIVE

      

1. Not taking time Hurried/Rushed (1 GAR, 1–6)1

2.60 (1.37)

2.80 (1.16)

2.53 (1.34)

2.62 (1.33)

.14 (−.52; .79) 7

.68

2. Not allowing a subject to be discussed disregard5

15

3

7

5

.24 (.02; 3.24) 8

.28

3. Not listening actively disagreement (=shows disapproval, criticism)5

0

0

2

2

- 9

−9

4 Not facilitating behaviour (2 GARs, 2–12)1

2.37 (.74)

2.30 (.61)

2.24 (.58)

2.35 (.71)

-.19 (−.51; .14) 7

.26

  1. 1 Observed mean rating (and standard deviation) of a (or of the sum of some) Global Affect Rating(s) (GARs) for the GP; the scale of each Global Affect Rating ranges from 1 to 6; interrater reliability of the GARs averaged 0.19 (range 0–0.39; these ICCs were rather low due to low variances in the GARs between consultations); 3 GARs ‘taking time’: calmness, speaking quietly, and showing involvement; 2 GARs ‘allowing any subject to be discussed’: GP’s open attitude and allowing any subject to be discussed; 5 GARs ‘facilitating behaviour’: interest/attentiveness, friendliness/warmth, responsiveness/engagement, sympathetic/empathetic, and respectfulness; 3 GARs ‘shared decision making’: with regard to treatment and care options taking patient’s quality of life and meaningfulness into consideration, informing patient adequately, and involving patient in decisions about treatment and care options; 1 GAR ‘not taking time’: (hurried/rushed); and 2 GARs ‘not facilitating behaviour’: anger/irritation and anxiety/nervousness.
  2. 2 Observed mean ratio (and standard deviation) of the total number of GP’s open questions divided by the total number of GP’s closed questions during a consultation; because at baseline in the intervention group two GPs scored respectively 27 and 33 while the range of the other scores was from 0 to 5.67, we replaced these two outlying scores by the third to highest score (namely 5.67) to prevent a disproportional influence of these two scores on the mean ratio.
  3. 3 Observed mean percentage (and standard deviation) of the total number of back channels by the GP divided by the total number of all utterances (including the back-channels) by the GP during a consultation; interrater reliability of the scores on the RIAS utterance back channel was 0.89.
  4. 4 Observed mean percentage (and standard deviation) of the total number of this type of utterance by the GP divided by the total number of all utterances (with the exception of the back-channels) by the GP during a consultation (the back-channels were excepted to prevent dominance of all results by the rather high en variable number of back-channels that were scored during the consultations when compared to the numbers of all other utterances); interrater reliability of the scores on the four RIAS utterances with a mean occurrence greater than 2% (verbal attention, personal remarks, check, and giving orientation) averaged 0.66 (range 0.56-0.75).
  5. 5 Observed percentage of consultations of the intervention and control group at baseline and post-measurement in which the GP made at least one utterance concerning this issue.
  6. 6 Observed mean ratio (and standard deviation) of the sum of the ratings for the extent to which the GP had discussed the treatment or care options concerning the addressed problems with the patient (= shared decision making, rating 1 to 4) divided by the number of problems that were addressed during the consultation.
  7. 7 Effect of intervention (95% confidence interval) using a linear mixed model, adjusted for baseline differences (years of experience as GP and urban versus rural/semi-rural practice location) and for possible influences of the GP’s sex, several actors simulating palliative care patients, and duration of the consultations longer than 15 minutes.
  8. 8 Odds ratio (95% confidence interval) using a logistic regression (GEE) model, adjusted for baseline differences (years of experience as GP and urban versus rural/semi-rural practice location) and for possible influences of the GP’s sex, several actors simulating palliative care patients, and duration of the consultations longer than 15 minutes.
  9. 9 The logistic regression (GEE) model is not fit for results of binomial data close to 0 or 100% respectively.
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BMC Primary Care

ISSN: 2731-4553

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