Question prompt lists and caregiver question asking in pediatric specialty appointments: A randomized controlled trial

Margaret Waltz; Haoyang Yan; R Jean Cadigan; Courtney Canter; Lizzy Bain; Jeannette T Bensen; Carol Conway; Chad Haldeman-Englert; Laura Farnan; Ann Katherine M Foreman; Tracey L Grant; Barbara Leach; Feng-Chang Lin; Madeline Mahla; Julianne M O'Daniel; Suzanne C O'Neill; Gerri Smith; Bradford C Powell; Jonathan S Berg; Christine M Rini

doi:10.1016/j.pec.2022.107620

Question prompt lists and caregiver question asking in pediatric specialty appointments: A randomized controlled trial

Patient Educ Couns. 2023 Apr:109:107620. doi: 10.1016/j.pec.2022.107620. Epub 2023 Jan 2.

Authors

Margaret Waltz¹, Haoyang Yan², R Jean Cadigan³, Courtney Canter⁴, Lizzy Bain⁵, Jeannette T Bensen⁶, Carol Conway⁷, Chad Haldeman-Englert⁸, Laura Farnan⁹, Ann Katherine M Foreman¹⁰, Tracey L Grant¹⁰, Barbara Leach¹¹, Feng-Chang Lin¹², Madeline Mahla¹⁰, Julianne M O'Daniel¹⁰, Suzanne C O'Neill¹³, Gerri Smith¹⁴, Bradford C Powell¹⁰, Jonathan S Berg¹⁰, Christine M Rini¹⁵

Affiliations

¹ Department of Social Medicine, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA. Electronic address: margaret_waltz@med.unc.edu.
² Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
³ Department of Social Medicine, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA.
⁴ Department of Anthropology, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA.
⁵ Parent/Advocate, Knightdale, NC, USA.
⁶ Department of Epidemiology, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA.
⁷ Parent/Advocate, Parent Advocates for Adult Children with Intellectual &/or Developmental Disabilities in NC, Chapel Hill, NC, USA.
⁸ Fullerton Genetics Center, Mission Health, Asheville, NC, USA.
⁹ Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
¹⁰ Department of Genetics, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA.
¹¹ Parent/Advocate, Family Support Program, School of Social Work, UNC Chapel Hill, Chapel Hill, NC, USA.
¹² Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹³ Department of Oncology, Georgetown University, Washington, DC, USA.
¹⁴ Parent/Advocate, Holly Springs, NC, USA.
¹⁵ Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA.

Abstract

Objective: Question prompt lists (QPLs) have been effective at increasing patient involvement and question asking in medical appointments, which is critical for shared decision making. We investigated whether pre-visit preparation (PVP), including a QPL, would increase question asking among caregivers of pediatric patients with undiagnosed, suspected genetic conditions.

Methods: Caregivers were randomized to receive the PVP before their appointment (n = 59) or not (control, n = 53). Appointments were audio-recorded. Transcripts were analyzed to determine questions asked.

Results: Caregivers in the PVP group asked more questions (Mean_PVP = 4.36, SD_PVP = 4.66 vs. Mean_control = 2.83, SD_control = 3.03, p = 0.045), including QPL questions (Mean_PVP = 1.05, SD_PVP = 1.39 vs. Mean_control = 0.36, SD_control = 0.81, p = 0.002). Caregivers whose child had insurance other than Medicaid in the PVP group asked more total and QPL questions than their counterparts in the control group (ps = 0.005 and 0.002); there was no intervention effect among caregivers of children with Medicaid or no insurance (ps = 0.775 and 0.166).

Conclusion: The PVP increased question asking but worked less effectively among traditionally underserved groups. Additional interventions, including provider-focused efforts, may be needed to promote engagement of underserved patients.

Practice implications: Patient/family-focused interventions may not be beneficial for all populations. Providers should be aware of potential implicit and explicit biases and encourage question asking to promote patient/family engagement.

Keywords: Genetic conditions; Patient engagement; Patient-provider communication; Pediatrics; Question prompt lists.

Publication types

Randomized Controlled Trial
Research Support, N.I.H., Extramural

MeSH terms

Caregivers*
Child
Communication*
Humans
Patient Participation
Physician-Patient Relations
Surveys and Questionnaires

Grants and funding

U01 HG006487/HG/NHGRI NIH HHS/United States