Patients from Birmingham-UK Use the Medical Interview Satisfaction Scale (MISS-21) to Feedback on Their Oncology Consultations, with and Without the Distress Thermometer.

BACKGROUND: Feedback on cancer care is key for evidence based and patient centered practice. UK oncologists are required to gather patient feedback on their performance. Patient feedback is used to improve medical care and is a significant predictor of key health outcomes. The Medical Interview Satisfaction Scale (MISS-21) gives clear, validated and normed feedback on clinical consultations. While the Distress Thermometer (DT) is now widely used, there is little evidence on its impact on doctor-patient communication. METHOD: Design: Pre and post, between subjects. Sample selection by convenience: 20 consecutive controls (no DT) followed by 20 consecutive intervention participants (with DT). Age range: 16 to 70. Gender: 51 males, 69 females. Procedure:120 patients feedback through the MISS-21 on consultations with three oncologists. 60 feedback: ‘treatment as usual’. 60 feedback: having completed and handed over the Distress Thermometer (DT) before the consultation. RESULTS: 1. Effect from the DT on MISS-21 The MISS-21 has four subscales: Communication Comfort, Rapport, Compliance Intent and Distress Relief. A Two-Way ANOVA showed significant improvement across all three clinicians in all four subscales with DT screening. 2. One-way ANOVA showed greater effect of DT on Communication Comfort and Rapport. 3. Patient Qualitative feedback. Impact of DT on Consultation: 33.3% ‘no’; and 66.7% ‘yes’: ‘It helps to open further in-depth discussion, increasing doctor-patient communication’ (30%). CONCLUSIONS: The MISS-21 is a quick and sensitive measure of patient feedback on cancer consultations. The DT improves patients’ satisfaction with their cancer consultation: greatest improvements in Communication Comfort and Rapport. Oncologists report that consultations were not negatively affected: similar content and consultation duration. RESEARCH IMPLICATIONS: Significant improvement in each MISS-21 subscale using DT. DT may highlight additional psycho-social concerns for discussion to be addressed in consultation. Positive effect on communication skills? Post hoc show that the subscales Communication Comfort and Rapport had strongest mean change (po.01). Supported by the qualitative feedback. CLINICAL IMPLICATIONS: Patient feedback to oncologists can improve clinical practice: the MISS-21 has proven a quick and sensitive measure, well accepted by patients and oncologists. The DT has brought immediate improvements in patient feedback on: Distress Relief (Can ease suffering, reduce unnecessary medical treatment and inappropriate referrals); Communication Comfort (Improved clinical history, improved patient outcomes); Rapport (Increased trust in clinician); Compliance Intent (Better treatment adherence, improved patient outcomes, and reduced medical expenses).