Why don't health professionals check patient understanding? A questionnaire-based study

Abstract

Checking patient understanding, by asking questions about information presented in a medical consultation, is a core communication skill but its use is not frequently assessed. The newborn hearing screening commenced in England with a pilot of its implementation in January 2002. Because it is a new screening test, it provided an opportunity for studying the effective communication of novel information. A randomized controlled trial of training newborn hearing screeners to present information about the screening test and to ask questions to check understanding was commenced but had to be prematurely ended as the majority of the screeners did not ask the questions. The aim of this study was to understand why the screeners did not ask questions to check understanding of the information provided. Questionnaires were sent to screeners who participated in the study to elicit their responses to the use of the questions to check understanding. A response rate of 87% (26/30) was achieved. Screeners who reported not asking the questions were more likely to express a lack of confidence in their ability to ask questions, and to perceive asking questions as an ineffective way of increasing patient understanding. The study suggests that the ability and willingness of healthcare professionals to use simple communication skills may have been overestimated and training needs to target skills as well as beliefs about the effectiveness of using them.

Keywords:

• Newborn hearing screeners
• shared decision-making
• checking understanding
• self-efficacy
• outcome expectations

Acknowledgement

This work was undertaken by the Evaluation Team for the Implementation Pilot of Newborn Hearing Screening, which received funding from the Department of Health. The views expressed in the publication are those of the authors and not necessarily those of the Department of Health.

Ethical approval

Ethical committee approval for the study was gained as part of approval granted by a multi-centred research ethics committee ref: MREC 01/8/49, dated 12 October 2001.