Are Patients Getting the Gist?
Blalock SJ, Slota C, Devellis BM, et al
Arthritis Care Res. 2014;66:542-550
The treatment armamentarium and approaches are rapidly changing for rheumatic diseases. This probably will result in improved outcomes for patients.
However, the complexity of the potential benefits, as well as side effects of these treatments and approaches, could be diminished if patients do not understand the role of these new treatments in their care. A concept central to this is "gist," which can be defined as the essential overall meaning to someone of a set of words and numbers used to convey information.
In this study, transcripts of audiotape recordings of patient/rheumatologist discussions about medications were evaluated by 4 individuals termed "gist coders." These 4 coders were all white women with rheumatoid arthritis (RA); in addition, they were all recruited by one of the coders, who was a leader of a local support group.
After reviewing the transcripts, the 4 coders then responded to a series of questions designed to describe the gist of what the rheumatologist had said. The questions addressed 14 gist themes involving medication effectiveness, need, and safety. For example, for the gist theme of safety, the coders reviewed the transcript and answered the following question about a medication: "The medication has X (few, many, or not clear) side effects."
The patients whose transcripts were evaluated all had RA, and they were from 2 regions in the United States (Wisconsin and North Carolina). They were predominantly female (77%), white (90%), and married (68%), and most had a high-school education or greater.
From a total of 365 patients, 4178 medication encounters were transcribed, although the 4 gist coders all provided coding for 264 of these medication encounters. The most common medications discussed were methotrexate and prednisone, followed by other medications commonly used for patients with RA, including anti-tumor necrosis factor (TNF) therapy, hydroxychloroquine, and agents to treat metabolic bone disease.
Overall, there was considerable variability in the agreement on the gist themes that the coders extracted from the transcripts. For example, for the gist theme of safety, as assessed by the question "The medication has few/many/not clear side effects," the agreement among coders was approximately 43% (kappa, 0.10). Conversely, there was high agreement (approximately 86% overall, with a kappa of 0.78) for the question "The rheumatologist wants to increase/keep the same/decrease/not clear the medication dose."
The study authors concluded that different people exposed to the same information may gain a different gist from it, and that patient/provider communication could be improved by understanding the factors that contribute to the formation of gist.
Patient-Rheumatologist Communication Concerning Prescription Medications: Getting to the Gist
Blalock SJ, Slota C, Devellis BM, et al
Arthritis Care Res. 2014;66:542-550
Study Summary
The treatment armamentarium and approaches are rapidly changing for rheumatic diseases. This probably will result in improved outcomes for patients.
However, the complexity of the potential benefits, as well as side effects of these treatments and approaches, could be diminished if patients do not understand the role of these new treatments in their care. A concept central to this is "gist," which can be defined as the essential overall meaning to someone of a set of words and numbers used to convey information.
In this study, transcripts of audiotape recordings of patient/rheumatologist discussions about medications were evaluated by 4 individuals termed "gist coders." These 4 coders were all white women with rheumatoid arthritis (RA); in addition, they were all recruited by one of the coders, who was a leader of a local support group.
After reviewing the transcripts, the 4 coders then responded to a series of questions designed to describe the gist of what the rheumatologist had said. The questions addressed 14 gist themes involving medication effectiveness, need, and safety. For example, for the gist theme of safety, the coders reviewed the transcript and answered the following question about a medication: "The medication has X (few, many, or not clear) side effects."
The patients whose transcripts were evaluated all had RA, and they were from 2 regions in the United States (Wisconsin and North Carolina). They were predominantly female (77%), white (90%), and married (68%), and most had a high-school education or greater.
From a total of 365 patients, 4178 medication encounters were transcribed, although the 4 gist coders all provided coding for 264 of these medication encounters. The most common medications discussed were methotrexate and prednisone, followed by other medications commonly used for patients with RA, including anti-tumor necrosis factor (TNF) therapy, hydroxychloroquine, and agents to treat metabolic bone disease.
Overall, there was considerable variability in the agreement on the gist themes that the coders extracted from the transcripts. For example, for the gist theme of safety, as assessed by the question "The medication has few/many/not clear side effects," the agreement among coders was approximately 43% (kappa, 0.10). Conversely, there was high agreement (approximately 86% overall, with a kappa of 0.78) for the question "The rheumatologist wants to increase/keep the same/decrease/not clear the medication dose."
The study authors concluded that different people exposed to the same information may gain a different gist from it, and that patient/provider communication could be improved by understanding the factors that contribute to the formation of gist.