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009 I have something to say
  1. Ana Carvajal-delaTorre1,
  2. Inmaculada Gómez-Besteiro2,
  3. Rosa Pita-Vizoso2,
  4. Roger Ruiz-Moral3
  1. 1Servicio Galego de Saude, Primary Care A Coruña, Spain
  2. 2Servicio Galego de Saude, Inibic, A Coruña, Spain
  3. 3Universidad Francisco de Vitoria, Madrid, Spain


Introduction Patient Initiated Actions (PIA) are patients’ verbal initiatives that do not respond to a direct doctor inquiry/are not expected during the conversation.

Through PIA, patients provide their perspective of what is important (barriers, preferences, fears, values) when making decisions.

The purpose of the study is to describe how patients take verbal initiative during decision-making consultations in Primary Care settings.

Methodology Design: Mixed-methods observational study using videotaped real consultations where a decision must be made. (N=206) from Primary Care settings in Spain.

Participants: Pairs of doctor-patients

Analysis: Qualitative and quantitative methods. Conversation analysis. Observation, transcription. Elaboration of a coding manual with categories:

-PIA: Moment, opening strategies, content, decisional stage, form of expression

-Doctor’s response (answering/not answering; types)

-Patient narrative: values, fears, concerns, preferences, needs, intentions & role in decision-making.

Results PIA identified in 75% of consultations; average n of PIAs = 4 First PIA is emitted at min 2,36 (0,10 to 9,22) 67% were emitted during face-to-face dialogue 51% without opening strategies 38% content related to symptoms or disease attributions 55% ideation stage, 27% planning, 18% action 34% were informative statements, 21% opinions, 15% expressions of concern Salient values are security, self-direction, personal achievement, and trust.Doctor’s response: 44% listen to the patient’s arguments; 33% also inquire about the PIA.

Discussion Patients display active behaviors early in the consultation. Through PIA, patients mostly inform and show concerns about symptoms and disease attributions. By introducing their perspective into the decision-making process, they contribute to the ‘shared problem understanding’ thus helping the doctor. Patients seem to show values and preferences to be validated by their physician before acting.

Conclusion Recognition and management of PIA should help clinicians identify patients’ needs and provide context to the decision-making process.

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