Savage & Armstrong

Cards (11)

  • 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