Article Figures & Data
Tables
Questions Control Group Intervention Group Q1 Pain and arthritis in hands limits times when I can use hands and pick things up I can't do normal adult things like workout, hangout with friends, and enjoy life because my weight and legs Seeing, hearing, teeth, independence Twist the lids off jar. Decreased grip or hand strength Just live like I want to workout play ball play with my kids Walking or playing with grandchildren, house work Work, walk long distances, stand long periods of time, and sometimes unable to just get out of bed Q2 Take road trips Get up in my chair better from the floor, get into bed and the shower without someone holding my chair Drive a car, climb a ladder Fishing, hunting, walking comfortably Walk a whole mile, walk faster and climb steps Walk and see better, would like to read, would like to dance Go on a vacation without having problems with my legs and feet Sex Q3 Time with family, church Hanging with friends and family; crafting Music, talking about positive aspects, my family, poetry Wheelchair basketball; sports being around people Music, spiritual ministries Books, my religion, my grandkids Spending time with family and friends, learning new things, travel, social interactions Conversation 1: Provider: What can you not do because of your health problems today? Patient: Uh, well, taking long trips. And, long walks. And that's about it. And working. Provider: Why is that? Patient: My back, the scoliosis. Provider: How long ago were you diagnosed? Patient: It's been some years I was born with it and I had rods in my back Patient: And so that, let me see. At 13 years. Gotcha. 9 scoliosis surgeries due to congenital scoliosis and seizures since 2003. And what's your living situation? Conversation 2: Physician: There is nothing you cannot do because of your health problems, right? Patient: No. Nothing is really stopping me. I mean, sometimes I recently started feeling. I guess it is side effects of the vitamin D deficiency like being really, really tired. Unbearably tired. Like in the middle of the day, barely being able to keep my eyes open tired. Provider: Wow Patient: And like last week it was the first week that it started to really like affect me. And I have been feeling these symptoms of stuff and I hadn't really felt them until just last week Provider: Anything about last week that was you think was causing you to feel tired all the time? Patient: Like social wise? Provider: Yeah? Patient: No, nothing. Regular week. Provider: And have you been eating pretty normally? Patient: Yes. Provider: So, what happens to you when you get unbearably tired in the middle of the day? How do you deal with that? Patient: I have to lay down or at least lay my head down Provider: For how long? Patient: Until I can manage to keep my eyes open. Physician: How are you sleeping? Patient: I wake up coughing and toss and turn all night. Physician screens for sleep apnea and orders sleep study. QOL, quality-of-life discussion.
Control Group (n = 15) Intervention Group (n = 15) Significance (P) Patient QOL goals mentioned 1 11 0.0378* Patient QOL goals used in clinical decision making 0 2 0.1334* Modified Flanders Physician talk 48.9% 47.0% 0.343† Patient talk 33.9% 35.2% 0.373† Direct communication 9.8% 7.5% 0.493† Indirect communication 27.5% 27.5% 0.275† Silence 17.5% 17.8% 0.260† Control Group (n = 15) Intervention Group (n = 15) Significance (P) Patient QOL goals mentioned 0 13 .0189* Patient QOL goals used in clinical decision making 0 2 .285* Modified Flanders Physician talk 44.1% 44.8% .5920† Patient talk 36.7% 36.2% .7015† Direct communication 6.1% 6.0% .7862† Indirect communication 26.6% 26.8% .7862† Silence 19.4% 18.2% .7053†
