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August 23, 2004
A Two-way Communication Checklist for Doctors Appointments
Evaluation of the Two-Way Communication Checklist as a clinical intervention. Results of a multinational randomized controlled trial.
Van Os J, Altamura AC, Bobes J, Gerlach J, Hellewell JS, Kasper S, Naber D, Robert P. Br J Psychiatry. 2004 Jan;184:79-83.
This European study used the Two-Way Communication Checklist (2-COM), which is a questionnaire that was developed with the aim of improving communication between patient and professionals. The 2-COM is a simple list of 20 common problems, or areas of perceived need that might be experienced by those with severe mental illness. The list includes problems with housing, relationships, money, lack of activities, psychological distress, sexuality, symptoms and treatment side-effects. In the study, patients are provided with the 2-COM prior to seeing their doctor and given simple instructions to help with its completion, guided on indicating which of the 20 problems apply to them and highlighting things they would like to discuss with their doctor during their clinic appointment. The authors report that using a completed checklist to guide discussion during the clinical interview extends the appointment by an average of 13 min.
In the study, individuals with schizophrenia were randomly assigned to either standard care with their doctor or additional use of the Two-Way Communication Checklist (2-COM) with their doctor. Before seeing their doctor for a routine follow-up, participants in the active intervention group were given the 2-COM. Outcomes were assessed immediately and again after 6 weeks. Using 2-COM resulted in a stable improvement of patient-reported quality of patient–doctor communication and perceived changes in management immediately after the intervention. The authors also report that although reported improvements in quality of communication were not influenced by the number or type of need, treatment change was more likely to occur in patients with higher levels of perceived need (e.g. inpatients). Furthermore, some needs such as the need for information about illness and treatment, were more likely to induce treatment changes than others. They suggest that the 2-COM produces needs-related changes in treatment immediately after the intervention, followed by a stable and durable improvement in quality of communication as perceived by the patient. As such, the 2-COM is a simple tool that can help people discuss their needs so that there can be better communication and changes in clinical management.
The limitations in this study include the possibility of bias by clinicians and patients in order to show that the 2-COM worked. Also, since the effect of the intervention was investigated over a period of 6 weeks; no conclusions can be drawn beyond that period. Furthermore, the results from this study suggest that patients with more perceived needs and greater levels of impairment are the ones who would benefit the most from 2-COM. Nevertheless, this study shows that structured communication about perceived needs can help in the treatment process.
The study was supported by an unrestricted grant from AstraZeneca. The authors state that AstraZeneca had no input into the design, conduct, analysis or reporting of the study.
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