SRs

Review detailsInterventionPopulationResultsQuality assessment+
Author (year)
Forster (2001)[101]

Objective
To examine the effectiveness of an information and/or education strategy to improve the outcome of stroke patients and/or their identified caregivers.

Number of included studies
2 RCTs and 7 CCTs
A program of lectures (n=3) or the provision of information in the form of leaflets, booklets or manuals (n=6)Patients with a diagnosis of stroke and/or their identified caregivers (and/or families)Knowledge: (1) Both of the studies that assessed information and educational sessions together indicated that these were associated with improved knowledge about stroke. (2) In the four trials that examined information only the results favoured the intervention but only weakly.

Emotional Outcome: No differences were observed in either anxiety or depression scores between the control and intervention groups in all 4 trials that assessed emotional outcomes (measured by BDI & HADS)

No significant differences between the groups were observed either in terms of perceived health status and quality of life, family functioning and patient adjustment, satisfaction with care, disability and handicap, service use or the modification of health related behaviours.

There is some evidence that information combined with educational sessions improved knowledge and was more effective than providing information only. Information provision only had no difference on mood, perceived health status or quality of life for patients or carers.
1: Good
2: Good
3: Good
4: Good
5: Good
Author (year)
Mc Pherson (2001)[102]

Objective
To review RCTs that evaluated methods of information giving to cancer patients and their families

Number of included studies
10 RCTs (14 comparisons)
Audiotapes of interviews (n=3), Audio-visual aids (n=2), Written information (n=6), Individually tailored patient care records (n=2), Patient educational programs(n=1).Patients with cancer; spouses were also included in 2 studies. In 5 of the studies patients were newly diagnosed.Indicated that the interventions had positive effects on a number of patient outcomes such as recall and knowledge, symptoms management, satisfaction, preferences, and health care utilization. This was above and beyond the usual care provision. However, in the majority of studies (8) the interventions had no difference on psychological indices.

It was also found that there was an interaction between disease prognosis and intervention. Where prognosis was poorer added information was detrimental.
1: Good
2: Good
3: Good
4: Good

5: Good
Author (year)
Scott (2001)[103]

Objective
To examine the effects of providing recordings or summaries of consultations to people with cancer and their families.

Number of included studies
8 RCTs
Offering or giving patients audiotaped recordings (n=7) or written summaries (n=1) of their consultations with practitioners.Adults diagnosed with cancer and their close families.4/6 studies reported better recall of information among the groups that received recordings or summaries than among control groups.

1/4 studies reported that patients who received a summary were more satisfied with the amount of information received. 1 study found that participants who received a tape of their consultation were more satisfied with their personalised tape than were those who received a general cancer information tape. However, the remaining 2 studies found no differences between the groups. 6 studies assessed anxiety and/or depression, and all found no differences between the groups that received and did not receive recording or summaries.

The studies reviewed suggest that most people with cancer seem to positively value being given a record of their consultation, and that this may enhance patients’ participation in subsequent consultations and in decisions about their care. There is no evidence that consultation tapes or summaries affects levels of anxiety or depression in people with cancer. Ultimately the use of consultation tapes or summaries is probably helpful for many patients, but not all. Each patients should therefore be assessed carefully in terms of their needs, preferences, access to support, and likely responses.
1: Fair
2: Good
3: Good
4: Good
5: Fair
Author (year)
Stewart (1995)[95]

Objective
To ascertain whether the quality of physician-patient communication makes a significant difference to patient health outcomes

Number of included studies
21 studies: 8 RCTs and 13 analytic studies
Studies of physician-patient communicationPatients of all ages, no medical speciality was excluded.Of the 21 studies, 16 reported positive results, 4 reported insignificant results and one was inconclusive.

The quality of communication both in the history-taking segment of the visit and during discussion of the management plan was found to influence patient health outcomes. The outcomes affected were: emotional health, symptom resolution, general functioning, physiologic measures and pain control.

When taking a history physicians should ask a wide range of questions not only about the physical aspects of the patient’s problem, but also about his or her feelings and concerns, understanding of the problem, expectations of therapy and perceptions of how the problem affects functioning. Patients need to feel that they are active participants in care and that their problem has been discussed fully. Patients should share in decision making when a plan for management is formulated. They should be encouraged to ask questions and given clear verbal information supplemented when possible by emotional support and written information packages. Agreement between patient and physician about the nature of the problem and the course of action appears to bode well for a successful outcome.
1: Good
2: Fair
3: NA
4: Good
5: Good
Author (year)
Walsh (1998)[96]

Objective
To examine different strategies for communicating ‘bad’ news.

Number of included studies
10 RCTs (15 comparisons)
Information package (n=10); follow-up telephone call (n=3); summary of consultation and audio-tape (n=2)Newly diagnosed adults with cancerKnowledge level: Varied between the 8 RCTs. In 4 trials there were no significant differences between groups, in 2 trials they were significantly increased in the experimental group and in the further 2 trials this was not reported.

Psychological adjustment: In 7/8 of the studies there were no significant differences between the groups. In 1 trial there was significant poorer adjustment in the experimental group.

Patient satisfaction: Varied between the 6 RCTs, with 3 of the trials showing that satisfaction was significantly increased in the experimental group and the remaining 3 trials reporting no significant differences between the groups.
1: Fair
2: Fair
3: Good
4: Good
5: Fair

From: Appendix I, Evidence tables

Cover of Multiple Sclerosis
Multiple Sclerosis: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care.
NICE Clinical Guidelines, No. 8.
National Collaborating Centre for Chronic Conditions (UK).
Copyright © 2004, Royal College of Physicians of London.

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