GPs use of Ideas, Concerns, Expectations, & Effects on life (GP-ICEE)
Research type
Research Study
Full title
Eliciting patients’ ideas, concerns, expectations, and effects on life: an observational study of routine general practice
IRAS ID
285177
Contact name
Peter J Edwards
Contact email
Sponsor organisation
Universtiy Of Bristol
Duration of Study in the UK
1 years, 11 months, 30 days
Research summary
Research Summary
Doctors are taught to explore patients’ ideas, concerns, and expectations (ICE) when assessing medical problems but it is not known how often this actually happens in routine UK GP consultations. Understanding how medical conditions impact on patients’ lives is a fundamental part of UK medical training and GP vocational training.
In 2015, a team from the Bristol University created an archive of over 300 filmed GP-patient consultations with permission for re-use to help answer future research questions. The patients had to be adults, consulting for themselves and give their written permission for their consultations to be recorded. The study took place at 12 different GP practices with 23 GPs. We aim to use this archive known as the ‘One in a Million’ dataset to assess how often ICE and effects on a patient's life (ICEE) are discussed in routine GP consultations for patients presenting with a least one new problem.
We aim to discover if GPs routinely ask patients about their ICEE or do patients raise these topics themselves. If patients present with multiple problems, do doctors take the time to assess ICEE for all of their problems or are problems that are raised earlier in the consultation assessed in more detail? We will also explore whether the frequency of ICEE affects patient satisfaction using the questionnaires patients filled out after their consultation and the doctors decision to write a new prescription or ordered a new investigation.
By understanding current practice, we hope to be in a strong position to make recommendations for improved medical training and subsequently patient care.
Summary of Results
Eliciting patients Ideas, Concerns, Expectations and whether their medical problem or associated treatment has an Effect on their activities of daily living (ICEE), is widely recommended in patient-centred consulting. However, it is not known how often ICEE occurs in UK GP consultations, and the international evidence on whether this affects patient outcomes is mixed. In this study, 9-in-10 GP consultations with adult patients presenting with at least one new problem included one or more ICEE components, although it was far more common for the patient to raise an ICEE component themselves rather than the GP directly asking about them. There were more ICEE components mentioned for problems that were acute and assessed by older GPs, and there were less ICEE components for problems assessed later in the consultation, by patients aged >75 years and living in the most deprived neighbourhoods, compared to the least deprived. The voicing of patient ideas was associated with increased patient satisfaction scores, whereas the opposite was true for patient concerns.
See full paper for more details:
Edwards P, Sellers GM, Leach I, Holt L, Ridd M, Payne R, Barnes RK. Ideas, Concerns, Expectations and Effects on life (ICEE) in GP consultations: an observational study using video-recorded UK consultations. British Journal of General Practice Open. 2023:BJGPO.2023.0008. DOI: https://doi.org/10.3399/BJGPO.2023.000"REC name
South Central - Oxford C Research Ethics Committee
REC reference
20/SC/0383
Date of REC Opinion
12 Oct 2020
REC opinion
Favourable Opinion