The Patient's First Point of Contact (PINPOINT)

The Patient's First Point of Contact (PINPOINT) - Protocol of a Prospective Multicentre Study of Communication and Decision-making During Patient Assessments by Primary Care Practice Nurses

The overall objective of this observational study is to investigate practices of communication and decision-making during nurses' initial assessment of patients' health problems in primary care, examine working mechanisms in good practices and develop feasible solutions.

The specific aims are:

1. To investigate patients' expectations and experiences with the communication and decision-making during their first contact with a registered nurse (RN) in primary care.
2. To investigate patient-RN communication on the level of patient involvement.
3. To investigate RNs' actual communication, assessments and decision-making, value conflicts and the challenges and strategies they use in prioritizing.
4. To analyse the underlying working mechanisms of good communication practices.
5. To develop methodologies for facilitating efficient processes in assessing, managing, and prioritizing patients in primary care for RNs.

Project PINPOINT aims for a prospective multicenter study, using various methods for data collection and analysis.

Study Overview

• Status: Recruiting
• Conditions: Nurse-Patient Relations
• Intervention / Treatment: Other: Observations to investigate the current practices of communication and decision-making during Nurse-patient consultations

• Study Type: Observational
• Enrollment (Estimated): 150

Contacts and Locations

• Study Contact: Name: Annelie Sundler, Professor; Phone Number: +4633 4354000; Email: annelie.sundler@hb.se

Study Locations

• Sweden
  • Borås, Sweden, 50190
    • Recruiting
    • University of Borås
    • Contact: Annelie Sundler, Professor; Email: annelie.sundler@hb.se

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Audio-recorded observations from a purposive sample of 150 patient-nurse consultations, including 30 nurses and 150 patients will be recruited at primary care centres in three different geographic areas of the southwest of Sweden.

Description

Inclusion Criteria:

• Registered Nurses at primary care centres and patients seeking primary care for a new health concern or a new episode of a problem

Exclusion Criteria:

• Patients visiting the primary care nurse with a chronic or continuous health problem

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient-reported expectations and experiences of the communication during consultations	Data will be gathered with the following questionaries: QUOTE-COMM, QUality Of care Through the patients' Eyes, and The COOP/WONCA, measuring functional health status. The QUOTE-COMM is used to gather patient reported data on expectations and experiences of communication aspects during consultations. At baseline the importance of (expectations) of various communication aspects are rated, and after experiences from the consultation, to evaluate to what extent RNs met patients' expectation. The COOP/WONCA is used at baseline to measure health status.	At baseline (day 1), after visit (day 1) and at 2-4 weeks
Communication processes and patient involvement as observed during consultations	Data will be gathered with audio recordings during real time consulltations. The observations with audio recordings will be coded with OPTION5, observing patient involvement in decision making, and the Verona Coding definition of emotional sequences, VR-CoDES. The OPTION5 scale is a reliable and valid instrument for investigating patient involvement in decision making. The Verona Coding Definitions on Emotional Sequences (VR-CoDES) is a reliable and valid instrument for coding of sequences of communication involving negative emotions, e.g., elicitations and expressions of patient cues and concerns, and RNs responses.	Day 1.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Assessment and decision-making processes, and related priorities and value conflicts - from observations and RN experiences	Data will be gathered with observations with audio recordings and interviews, and analysed with qualitative methods to gain insights on assessments and decision-making processes during consultations, and related priorities and value conflicts	Through study completion, an average of 1 year

Collaborators and Investigators

• Sponsor: University of Boras
• Collaborators: Vastra Gotaland Region; Netherlands Instititute for Health Services Research; Mälardalen University
• Investigators: Principal Investigator: Annelie Sundler, Professor, University of Borås

Study record dates

Study Major Dates

• Study Start (Actual): August 15, 2023
• Primary Completion (Estimated): December 31, 2027
• Study Completion (Estimated): December 31, 2027

Study Registration Dates

• First Submitted: September 25, 2023
• First Submitted That Met QC Criteria: October 2, 2023
• First Posted (Actual): October 5, 2023

Study Record Updates

• Last Update Posted (Actual): October 5, 2023
• Last Update Submitted That Met QC Criteria: October 2, 2023
• Last Verified: October 1, 2023

More Information

Terms related to this study

• Keywords: Nurse; Primary care; Decision-making; Communication
• Other Study ID Numbers: FO2023/171

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Data supporting these findings are not publicly available due to the participants' privacy, the General Data Protection Regulation (GDPR) law, and the ethical approval from the Swedish Ethical Review Authority.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No