Ideas, Concerns, Expectations and Effects on life (ICEE) in GP consultations: an observational study using video-recorded UK consultations.
Edwards P., Sellers GM., Leach I., Holt L., Ridd M., Payne R., Barnes RK.
BACKGROUND: Eliciting patients' Ideas, Concerns, Expectations, and whether a problem has an Effect on their life (ICEE), is a widely recommended communication technique. However, it is not known how frequently ICEE components are raised in UK GP consultations. AIM: Assess the frequency of ICEE in routine GP consultations with adult patients and explore variables associated with ICEE. DESIGN AND SETTING: Secondary analysis of face-to-face video-recorded GP consultations archive. METHOD: Observational coding of 92 consultations. Associations were assessed using binomial and ordered logistic regression. RESULTS: Most consultations included at least one ICEE component (90.2%). The most common ICEE component per consultation was patient ideas (79.3%), followed by concerns (55.4%), expectations (51.1%) and then effects on life (42.4%). For all ICEE components, patients more commonly initiated the ICEE dialogue and in only three consultations (3.3%) GPs directly asked patients about their expectations.Problems that were acute (OR 2.98, 95% confidence interval [CI]=1.36-6.53, P=0.007) or assessed by GPs ≥50 years (OR 2.10, CI =1.07-4.13, P=0.030) were associated with more ICEE components. Problems assessed later in the consultation (OR 0.60 per problem order increase, CI =0.41-0.87, P=0.007), by patients ≥75 years (OR 0.40, CI =0.16-0.98, P=0.046) and from the most deprived cohort were associated with fewer ICEE components (OR 0.39, CI =0.17-0.92, P=0.032). Patient ideas were associated with more patients being 'very satisfied' post-consultation (OR 10.74, CI =1.60-72.0, P=0.014) and the opposite was true of concerns (OR 0.14, CI =0.02-0.86, P=0.034). CONCLUSION: ICEE components were associated with patient satisfaction and demographic variables. Further research is required to assess if the way ICEE are communicated affects these associations and other potential confounders.