A Cochrane review [Abstract] 1 included 33 randomised controlled trials, with a total of 8244 patients. The most common interventions were question checklists and patient coaching. Most interventions were delivered immediately before the consultations.
Commonly-occurring outcomes were: question asking, patient participation, patient anxiety, knowledge, satisfaction and consultation length. A minority of studies showed positive effects for these outcomes. Meta-analyses, however, showed small and statistically significant increases for question asking (standardised mean difference SMD 0.27; 95% confidence interval [CI] 0.19 to 0.36) and patient satisfaction (SMD 0.09; 95% CI 0.03 to 0.16). There was a notable but not statistically significant decrease in patient anxiety before consultations (weighted mean difference WMD -1.56; 95% CI -7.10 to 3.97). There were small and not statistically significant changes in patient anxiety after consultations (reduced) (SMD -0.08; 95% CI -0.22 to 0.06), patient knowledge (reduced) (SMD -0.34; 95% CI -0.94 to 0.25), and consultation length (increased) (SMD 0.10; 95% CI -0.05 to 0.25). Further analyses showed that both coaching and written materials produced similar effects on question asking but that coaching produced a smaller increase in consultation length and a larger increase in patient satisfaction.
Interventions immediately before consultations led to a small and statistically significant increase in consultation length, whereas those implemented some time before the consultation had no effect. Both interventions immediately before the consultation and those some time before it led to small increases in patient satisfaction, but this was only statistically significant for those immediately before the consultation. There appear to be no clear benefits from clinician training in addition to patient interventions, although the evidence is limited.
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