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10 Ideas, concerns and expectations (ICE) in general practice consultations – report of a mixed methods study
  1. Larissa Burggraf,
  2. Stefanie Stark,
  3. Angela Schedlbauer,
  4. Thomas Kühlein,
  5. Marco Roos
  1. Institute of General Practice, Friedrich-Alexander-Universität Erlangen-Nuremberg, Erlangen, Germany


Objectives In General Practice consultations the patient’s agenda frequently remains hidden. ICE (Ideas, Concerns and Expectations) is a concept in consultation skills training to elicit the patient’s agenda. It has been shown to reduce overdiagnosis and overtreatment. The objective of this study was to implement ICE as a tool for practicing patient-centered-communication and to test its effect on prescribing and referral. Acute low back pain causes a high level of suffering putting pressure on physicians to act. We aim to answer the following questions:

  1. Does a Training Intervention of ICE in General Practice have an effect on medical overdiagnosis or overtreatment in the care of patients with low back pain?

  2. What is the perception of General Practitioners (GP) on Patient–centeredness?

  3. Is there an effect on patients‘ satisfaction when General Practitioners adopt Patient–centered–communication by eliciting ICE?

Method In a cluster-randomized trial we planned to test a training intervention on consultation skills using ICE. The planned outcome was the number of referrals for imaging or secondary care of patients with low back pain. The training included a self-reflection on participants’ consultation skills as well as their usual diagnostic and treatment procedures of patients with acute low back pain. Within the training the perception of patient-centeredness of practitioners in daily practice was observed by using the qualitative ethnographic method of participatory observation. Accompanying the RCT we conducted a patient and doctor’s survey for testing satisfaction with patient-centeredness using an expectation-experience-comparison.

Results The RCT as originally planned failed due to high recruitment problems (15 instead of 48 practitioners). Therefore we decided to strengthen the qualitative part of the study also for explaining these difficulties. The participatory observation showed that practitioners attribute patients’ satisfaction only with the fulfillment of patients’ expectations, even if the following procedures lead to medical overdiagnosis and overtreatment. Furthermore, the reflection of practitioners showed more important influencing factors on the outcome of the consultation. The practitioners’ needs in daily practice were possibly not met by a seemingly good idea of how to better consult.

Conclusions In the light of the results, we want to discuss whether medical care of patients (with acute low back pain) is changeable by using a patient-centered communication technique like ICE or is patient-centered communication overestimated in its potency of effects on the outcome of a consultation in general practice.

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