Patient-centered interviewing

Are your patients telling you about their bowel symptoms?

39% of patients with IBS report feeling embarrassed about their symptoms1

10% of patients with IBS report delaying seeking medical advice due to embarrassment1

GI symptoms, such as constipation or diarrhea, often represent a “door knob” question, meaning patients wait until the last minute to mention these symptoms or do not mention them at all

In a survey, a greater proportion of people said they were uncomfortable talking about bowel movements, compared to talking about sex or erectile dysfunction1

People experiencing IBS symptoms often perceive stigma from their significant others and healthcare professionals, and so may not volunteer information about their symptoms, even when they are impacting their quality of life2

What is patient-centered interviewing and why is it important?

Patient-centered interviewing is a technique whereby the patient is encouraged to lead the discussion, thereby allowing the conversation to be steered by the patient’s experiences, worries, preferences, and expectations3,4

Using a patient-centered approach involves curiosity and patience, and allows a therapeutic bond to develop between the patient and the healthcare professional3,4

Patient-centered interviewing ensures that patients feel listened to and understood, and are therefore more comfortable sharing information about all their symptoms and feelings, which is especially important for patients who may have IBS

More effective provider–patient communication is associated with improved patient outcomes and increased patient satisfaction5,6

Healthcare professionals trained in patient-centered interviewing experience increased professional and personal satisfaction, and consider themselves better able to help their patients7,8

What are the key elements of a patient-centered interview?4,7

Step 1: Setting the stage

It is important to make the patient feel comfortable; welcome them by name and introduce yourself, including your name and role

Step 2: Setting the agenda

Allow the patient to identify all of the issues they wish to discuss during the visit, and identify how the patient understands their illness from their personal perspective. Questions such as "What brought you here today?"  or "What worries or concerns do you have?" can help establish a dialogue and mutually agreed goals

Step 3: Non-focused interviewing

Ask open-ended questions and listen actively, using verbal and non-verbal cues (e.g. eye contact) to convey empathy and understanding in a nonjudgmental fashion

Step 4: Focused interviewing

Obtain more information about the specific symptoms and emotions the patient is experiencing. Patients with symptoms of IBS often feel stigmatized, or fear that their symptoms will be trivialized, so it is important that providers accept the reality of the disorder and maintain an air of openness in order to validate the patient’s feelings and avoid shutting down communication

Step 5: Transition to doctor-centered process

Provide a brief summary of the discussion and indicate that you would now like to discuss next steps in terms of diagnosis and management. It is important to set realistic goals for managing a chronic condition such as IBS, as some patients may expect a cure. It is also important to provide education and reassurance, and to reach an agreement on the management plan and expectations

Use of patient-centered communication skills can actually save time by establishing a satisfying relationship with only a few simple techniques7

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References

  1. American Gastroenterological Association. IBS in America Survey. 2015. Available at: http://ibsinamerica.gastro.org/.
  2. Taft TH et al. Neurogastroenterol Motil 2014; 26: 1026-1035.
  3. Platt FW et al. Ann Intern Med 2001; 134: 1079-1085.
  4. Lyles JS et al. J Clin Outcomes Manag 2001; 8: 28-34.
  5. Stewart MA. CMAJ 1995; 152: 1423-1433.
  6. Beck RS et al. J Am Board Fam Pract 2002; 15: 25-38.
  7. Drossman DA. Am J Gastroenterol 2013; 108: 521-528.
  8. Hall JA et al. Patient Educ Couns 2002; 48: 69-77.