Delivering the faecal occult blood test: More instructions than shared decisions. A qualitative study among French GPs

Figures & data

Table 1. Characteristics of GPs, their practice and their recruitment.

GP	1	2	3	4	5	6	7	8	9
Age	58	52	32	29	51	63	59	33	49
Gender	M	M	F	F	F	M	M	M	F
Year practice set up	1985	1987	2009	Not yet	1988	1979	1978	Not yet	1995
Size of Practice	Group	Single	Group	Group	Group	Single	Group	N/A	Group
Location	Urban	Urban	Rural	Urban	Urban	Urban	Rural	Rural	Urban
Teaching GP?	Yes	Yes	No	No	No	Yes	Yes	No	Yes
Year of first prescription of FOBT	2006	2005	2008	2008	2007	2000	N/A	2007	2000
Number of consultations recorded	4 (5 patients)	4	5	5	4	4	3	3	3

N/A: not available.

Table 2. Quotes: GPs and patients’ statements (in bold, the one who spoke).

	Quotes
Patients’ medical history	Q1: ‘Are there any bowel problems in your family?’ (GP 2^a, patient 1) Q2: ‘At the present time, don't you have blood in your faeces or problems with your last bowel movements?’ (GP 3^a, patient 3)
Technical explanations	Q3: ‘So you have a leaflet but I am going to give you some explanations.’ (GP 3^a, patient 1)
Colonoscopy	Q4: ‘There is often a little damage to your bowels which could bleed and generally you need a colonoscopy.’ (GP 4^a, patient 3)
Follow-up to the test	Q5: ‘If you have blood in your bowels, it is not necessarily serious … not necessarily a cancer.’ (GP 4^a, patient 2)
Arguments to convince patients	Q6: ‘There are 32 000 people, a little more than 32 000 people affected by colorectal cancer per year in France and about 16 000 deaths …’ (GP 6^a, patient 3)
The test	Q7: ‘And there will be 5 or 6 patients with a normal colonoscopy; they will have been bothered for nothing…’ (GP 6^a, patient 3)
Patients’ questions	Q8: ‘So three days?’ (GP 7, patient 2^a)
	Q9: ‘And what do I do if I have two stools a day?’ (GP 5, patient 3^a)

^aThe one who spoke.

Table 3. GPs’ content of discussion during the consultation.

Communication category	Number of utterances (% utterances)	Combination of RIAS categories
Data gathering—biomedical	150/1830(8.2%)	Asks closed-ended questions-medical conditions: 83
		Asks closed-ended questions-other: 36
		Asks open-ended questions-medical conditions: 11
		Asks open-ended questions-other: 20
Patient education and counselling—biomedical	1068/1830(58.3%)	Gives information-medical conditions: 252
		Gives information-other: 816
Facilitation and patient activation	167/1830(9.1%)	Asks for opinion: 2
		Asks for permission: 2
		Asks for reassurance: 1
		Asks for understanding: 126
		Back channel responses: 7
		Check for understanding: 29
Rapport-building: positive	117/1830(6.4%)	Laughs—tells jokes: 22
		Shows approval: 20
		Shows agreement: 68
Rapport-building: negative	7/1830(0.3%)	Shows criticism: 5
		Shows disapproval: 2
Rapport-building: emotional	170/1830(9.3%)	Empathy: 3
		Legitimization: 3
		Shows concern or worry: 19
		Reassures encourages or shows optimism: 144
		Partnership statements: 1
Rapport-building: social	17/1830(0.9%)	Personal remarks—social conversation: 15
		Self-disclosure: 2
Procedural	141/1830(7.8%)	Gives orientation—instructions: 141

Table 4. Patients’ content of discussion during the consultation.

Communication category	Number of utterances 946 (% utterances)	Combination of RIAS categories
Question asking—biomedical	66/946(6.9%)	All questions-medical: 4
		All questions-other: 54
		Bid for repetition: 8
Question asking—lifestyle/psychosocial	1/946(0.1%)	All questions-lifestyle: 1
		All questions-psychosocial: 0
Information giving—biomedical	203/946(21.4%)	Gives information-medical condition: 81
		Gives information—other: 122
Information giving—lifestyle/psychosocial	3/946(0.3%)	Gives information-lifestyle: 2
		Gives information—psychosocial: 1
Patient activation and engagement	134/946(14.1%)	Asks for reassurance: 72
		Asks for understanding: 16
		Check for understanding: 46
Rapport-building: positive	465/946(49.2%)	Laughs—tells jokes: 16
		Shows approval: 85
		Gives compliment: 2
		Shows agreement: 356
Rapport-building: negative	6/946(0.63%)	Shows criticism: 4
		Shows disapproval: 2
Rapport-building: emotional	19/946(2.1%)	Legitimization: 2
		Shows concern or worry: 9
		Reassures, encourages or shows optimism: 8
Rapport-building/social	54/946(5.8%)	Personal remarks—social conversation: 54
Procedural	1/946(0.1%)	Gives orientation—instructions: 1

Figure 1. Patient-centred communication and verbal dominance for all sampled GPs.