This PhD examines the communicative and relational processes in consultations in outpatients' clinics at Odense University Hospital (OUH). The main aim is to investigate the opportunities, prerequisites and motivators for patient engagement through patient feedback and ultimately the phenomenon of patient feedback. The research questions are exploratory and the research is qualitative and uses ethnographic methods and has a participatory approach.
Over the past 20 years there has been an increasing focus in clinical practice on involving patients in their treatment in order to enhance quality and safety. Research on patient engagement has been similarly increasing. Fleming et al. state that the number of research articles on patient engagement increased from 33 in 2010 to 512 in 2018 . Research shows that patient involvement is essential for patient safety as it results in a more accurate and better timed diagnosis, improved joint decision-making, safe medication and reduction of adverse events [2-10]. In addition, patient involvement is also crucial for patients' experience of confidence, empowerment and satisfaction [1,11,12] and for improving quality and organisational development in healthcare organisations [13,14,15].
Increasing focus on patient engagement in communication
Since the definition of diagnostic error in 2015 was changed into including failing communication with patients, there has been an increasing focus on patient engagement in communication and how the perspective of the patient can be heard [3, 6, 9]. Already in 2006, Epstein explored communication and informal patient feedback in consultations with the aim of increasing safety for the individual patient. He argues that patients who use assertive responses and ask questions induce patient-centred communication behaviour and partnering statements . Dahm et al. argue that patient engagement and patient safety are affected by a lack of awareness of patient-driven interpersonal communication between patients and healthcare professionals. They find that communicative behaviours of healthcare professionals such as interruptions, lack of listening and biased labelling affect patients negatively in giving feedback in the diagnostic process. Thus, there is a need for research into how diagnostic communication can move towards becoming patient-driven . Weiner & Schwartz similarly provide evidence of how inattention to patient context in consultations lead to medical errors . Street et al. provide an example of how patients and their relatives experience the role of communication in patient safety. They report that communication breakdowns such as information inadequacy or if the healthcare professional is not listening to or being dismissive of a concern can lead to medical errors while effective communication and persistent or assertive communication by a patient or family member can prevent mistakes .
The phenomenon of patient feedback
There is to date limited research into patient-driven communication in consultations and the use of patient feedback [10,14]. Patient feedback can be defined as patients and relatives sharing observations, curious questions or emotions, thoughts and experience with healthcare professionals in the belief that it is valuable and relevant . Patient feedback can, for example, be both the immediate response of the patient to what the healthcare professional says and it can be a reflective statement or opinion based on either disagreement or encouragement. Feedback can be a response to the technical or practical details of treatment, personal or existential considerations, or revolve around the communication as such, for example addressing the interpersonal relationship.
Description of the cohort
Research take place at the outpatients' clinics at the departments of Medical Gastrointestinal Diseases, Respiratory Medicine and Rheumatology. Here the head of departments have expressed high motivation for developing patient communication in clinical practice and the number of vulnerable patients with chronical or comorbid diseases are high. The project includes vulnerable groups with the aim of ensuring variation in the population and giving voice to patients with differentiated resources, interests and understandings of engagement.
Data and biological material
Qualitative data from observations, interviews, recording of consultations, workshops
Collaborating researchers and departments
Deakin University's School of Medicine, Australia, Peter Martin, Prof. of Clinical Communication and End of Life Care
- Department of Regional Health University (IRS) and Research Unit PROgrez, Region of Zealand, Ditte Høgsgaard, ph.d., assistant Prof.
- Department of Respiratory Medicine, OUH,Jesper Rømhild Davidsen, Associate Prof., MD, PhD, Head of PURE (PUlmo-RhEuma Clinic OUH) and SCILS (South Danish Center for Interstitial Lung Diseases)
- Department of Medical Gastrointestinal Diseases, OUH, Benedicte Vibjerg Wilson, Head of Department
- Department of Language and Communication, SDU, Sune Vork Steffensen, ph.d., Prof.