Test talk: exploring the discussion of blood tests in primary care
Research type
Research Study
Full title
Test talk: a mixed methods study exploring the discussion of blood tests between doctors and patients in primary care
IRAS ID
246955
Contact name
Jessica Watson
Contact email
Sponsor organisation
Head of Research Governance, University of Bristol
Duration of Study in the UK
0 years, 11 months, 31 days
Research summary
Research Summary
Despite research exploring motivations for investigations and broad methods of conveying results in primary care, there is relatively little evidence about what occurs during consultations between GPs and patients, including what discussion precedes the decision to carry out investigations and how the subsequent results are discussed.
This study will explore how doctors and patients discuss investigations in general practice, both in the context of ordering investigations and discussing results. Due to time constraints, we will focus on consultations discussing blood tests.
More specifically, we will investigate:
1. Whether there is shared decision making between patients and doctors surrounding blood tests
2. Whether blood tests are requested by patients or offered by doctors
3. Reasons for ordering blood tests as implied by the doctor
4. How results are explained to patients, including information about what results mean, both before and after the test has been carried out.We will identify up to 50 consultations which discuss blood tests and analyse the video recordings to examine key aspects of the discussion surrounding investigations. We will look at things such as whether the patient asks for a test or the doctor offers it, whether the doctor explains what the result of the test might mean before the test is done, and how much doctors explain the risks and flaws of tests before they are done.
This study will not collect any new data. We will use data previously collected for the ‘One in a Million’ study at the University of Bristol (REC reference number 14/SW/0112), which created a database of video recordings of primary care consultations from a variety of general practices in the west of England.
Summary of Results
Background Blood tests are commonly used in general practice. Understanding blood tests is important for patients to help them to become partners in their care and manage their health. Shared-decision making is widely recommended but there is a lack of research into how doctors shared decisions about blood tests.
Aim
This study aimed to find out how doctors talk about blood tests to patients in routine primary care consultations, and whether decision making is shared.
Methods
We looked at 50 video-recorded routine primary care consultations from 22 GPs across 12 practices, plus linked survey and records data, from the One in a Million archive.
Results
In 36/50 consultations which discussed ordering blood tests, 31% of patients hinted they wanted a blood test, however none explicitly asked. Only 11% were offered alternative options. In 81% of cases the GP gave some explanation of the reason for testing, but only 17% explained limitations of testing. Only 32% of patients were informed about all blood tests ordered.
Of 23/50 consultations in which results were conveyed, the GP gave no explanation of the results in 26% of cases. 57% of patients were only informed of an 'assessment' (e.g. ‘normal’), rather than the actual result Conclusion A lack of information-giving and shared-decision making exists surrounding ordering tests and sharing results. Improving shared-decision making could reduce unnecessary testing and improve patient-centred care.REC name
West Midlands - Coventry & Warwickshire Research Ethics Committee
REC reference
18/WM/0241
Date of REC Opinion
10 Aug 2018
REC opinion
Favourable Opinion