The impact of patient-generated contextual data on communication in clinical practice: A qualitative assessment of patient and clinician perspectives

• Published in: Patient education and counseling 2020-04, Vol.103 (4), p.734-740
• Main Authors: Cusatis, Rachel, Holt, Jeana M., Williams, Joni, Nukuna, Sandile, Asan, Onur, Flynn, Kathryn E., Neuner, Joan, Moore, Jennifer, Makoul, Gregory, Crotty, Bradley H.
• Format: Article
• Language: English
• Subjects: Communication; Focus Groups; Health information technology; Humans; Nursing; Patient contextual data; Patient-Centered Care; Patient-centered communication; Patient-provider communication; Qualitative Research; Trust
• ISSN: 0738-3991; 1873-5134
• DOI: 10.1016/j.pec.2019.10.020

•Patient contextual data (PCD) fostered rapport among patients and healthcare team.•The PCD tool enabled patient/provider communication outside the clinic visit.•Participants recognized the PCD tool offered space to communicate sensitive topics.•Recording and reviewing PCD ahead of visit better prepares patients and providers. Effective communication is integral to patient-centered care, yet external pressures can impede the ability to discuss important topics. One strategy to facilitate communication is pre-visit collection and sharing of patient contextual data (PCD), including life circumstances such as their beliefs, needs, and concerns. To understand how patients and care team members perceive the electronic collection of PCD and its impact on communication in the context of a large academic health system that implemented PatientWisdom, a new technology that elicits PCD from patients and integrates within the electronic health record (EHR). We conducted focus groups with patients (n = 26) and semi-structured interviews with primary care team members (n = 20). Qualitative analysis of focus group/interviews included an iterative and reflexive inductive technique to uncover emergent themes. Four themes were reflected among both patient and care team: (1) the technology enhances the patient’s voice; (2) the technology creates a safe space for patients to share sensitive topics; (3) PCD facilitates rapport not only between patient and provider but the entire care team; (4) PCD aligns patient and clinician goals. Two unique themes emerged among patients: (1) PCD provides opportunity for reflection; (2) PCD humanizes patients in the clinical context. One theme was evident in provider comments: collecting PCD may potentially undermine trust if not reviewed by clinical teams. PCD collected directly from patients and available within the EHR was seen by patients and care team members as beneficial to communication. PCD collection supports a paradigm shift towards coproduction of health information and a shared responsibility for information gathering but requires investment from patients and care team to ensure the data are effectively utilized. PCD may be useful for team-based care, enabling physicians and non-physician staff to more quickly and responsively connect with patients.