Savage & Armstrong

• What are they investigating?

  Investigate whether patient satisfaction is increasing with a sharing or directed style of consultation
• Methodology


  Field experiment; inner London general practice

  Random allocation to the 2 groups via cards.

  Data collected by a questionnaire
• Sample


  200 randomly sampled patients

  Completed 2 questionnaires

  Random number generator was used to select 4 patients from each surgery the doctor held over a period of four months

  Gave consent for audio recording
• Procedure


  Participants randomly allocated to the IV conditions (sharing or directed) with cards on table. Cards placed face down and card allocated to patient was overturned after standardised introduction and participants seen as viable for the study

  Part of consultation: judgement of consultation, diagnosis, treatment, prognosis, follow up and closer

  Sharing style: "why do you think this happened" "what do these symptoms mean to you"

  Directed style "this is/is not a serious problem" "you should be better in...days"

  Then asked to complete questionnaire
• Questionnaires and dependant variable

  Given a questionnaire after study

  Questions: "i was able to discuss my problem well", "I felt much better" etc.

  Second questionnaire with stamp envelope was given and told to post it back one week later
• Results


  No significant difference in terms of age, sex or ethnicity

  On initial questionnaire more participants in directed style agreed with "i received an excellent explanation"

  More individuals in directed style agreed with statement "i perceived the general practitioner to have a complete understanding" on both questionnaires

  No significant different on two groups on initial questionnaire with statement "i felt much better", but on follow up more directed style agreed
• Conclusions

  Directed style led to greater patient satisfaction; patients prefer certainty

  Patients with simple physical illnesses benefit more from a directed style of consultation
• Strengths of the study

  Used patients coming in for actual consultations - high eco validity

  Random sampling; patients are representative of patients in doctors surgery, not just patients her knew well or replied well to consultation
• Weakness of the study

  Doctor followed prompts and may have felt less relaxed which could affect questionnaire results; lowering validity

  Not generalisable
• Issues and debates


  Offer situational explanations and ignore individual differences e.g directed was only better for some/ some already knew about their diagnosis.
• Ethical issue


  Had participants consent

  Right to withdraw

  Exclude participants with life threatening conditions