Toronto General Hospital Research Institute, University Health Network, Toronto, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
Health Expect. 2023 Aug;26(4):1404-1417. doi: 10.1111/hex.13783. Epub 2023 May 25.
Question prompt lists (QPLs) are lists of questions that patients may want to discuss with clinicians. QPLs support person-centred care and have been associated with many beneficial outcomes including improved patient question-asking, and the amount and quality of the information provided by clinicians. The purpose of this study was to review published research on QPLs to explore how QPL design and implementation can be optimized.
We performed a scoping review by searching MEDLINE, EMBASE, Scopus, CINAHL, Cochrane Library and Joanna Briggs Database from inception to 8 May 2022, for English language studies of any design that evaluated QPLs. We used summary statistics and text to report study characteristics, and QPL design and implementation.
We included 57 studies published from 1988 to 2022 by authors in 12 countries on a range of clinical topics. Of those, 56% provided the QPL, but few described how QPLs were developed. The number of questions varied widely (range 9-191). Most QPLs were single-page handouts (44%) but others ranged from 2 to 33 pages. Most studies implemented a QPL alone with no other accompanying strategy; most often in a print format before consultations by mail (18%) or in the waiting room (66%). Both patients and clinicians identified numerous benefits to patients of QPLs (e.g., increased patient confidence to ask questions, and patient satisfaction with communication or care received; and reduced anxiety about health status or treatment). To support use, patients desired access to QPLs in advance of clinician visits, and clinicians desired information/training on how to use the QPL and answer questions. Most (88%) studies reported at least one beneficial impact of QPLs. This was true even for single-page QPLs with few questions unaccompanied by other implementation strategies. Despite favourable views of QPLs, few studies assessed outcomes amongst clinicians.
This review identified QPL characteristics and implementation strategies that may be associated with beneficial outcomes. Future research should confirm these findings via systematic review and explore the benefits of QPLs from the clinician's perspective.
PATIENT/PUBLIC CONTRIBUTION: Following this review, we used the findings to develop a QPL on hypertensive disorders of pregnancy and interviewed women and clinicians about QPL design including content, format, enablers and barriers of use, and potential outcomes including beneficial impacts and possible harms (will be published elsewhere).
问题提示清单 (QPL) 是患者可能希望与临床医生讨论的问题清单。QPL 支持以患者为中心的护理，并且与许多有益的结果相关，包括提高患者提问的次数、以及临床医生提供的信息量和质量。本研究的目的是综述已发表的 QPL 研究，以探讨如何优化 QPL 的设计和实施。
我们通过检索 MEDLINE、EMBASE、Scopus、CINAHL、Cochrane 图书馆和 Joanna Briggs 数据库，从成立到 2022 年 5 月 8 日，对任何设计评估 QPL 的英语语言研究进行了范围界定审查。我们使用汇总统计数据和文本报告研究特征、QPL 设计和实施。
我们纳入了 1988 年至 2022 年期间，来自 12 个国家的作者发表的 57 项研究，涉及多种临床主题。其中，56%的研究提供了 QPL，但很少有研究描述 QPL 是如何开发的。问题的数量差异很大（范围 9-191）。大多数 QPL 是单页的活页夹（44%），但也有 2-33 页的 QPL。大多数研究单独实施 QPL，没有其他伴随策略；最常见的是在邮件咨询前（18%）或在候诊室（66%）以印刷形式实施。患者和临床医生都发现 QPL 对患者有很多好处（例如，增加患者提问的信心和对沟通或护理的满意度；降低对健康状况或治疗的焦虑）。为了支持使用，患者希望在就诊前获得 QPL，而临床医生则希望获得有关如何使用 QPL 和回答问题的信息/培训。大多数（88%）研究报告了 QPL 的至少一项有益影响。即使是单页 QPL，问题较少，没有其他实施策略，情况也是如此。尽管对 QPL 的看法良好，但很少有研究评估其对临床医生的结果。
本综述确定了可能与有益结果相关的 QPL 特征和实施策略。未来的研究应该通过系统综述来证实这些发现，并从临床医生的角度探讨 QPL 的益处。
患者/公众贡献：根据本综述，我们使用这些发现开发了一份关于妊娠高血压疾病的 QPL，并就 QPL 的设计对女性和临床医生进行了采访，包括内容、格式、实施障碍和促进因素，以及潜在的结果，包括有益的影响和可能的危害（将在其他地方发表）。
