Summary Table. Summary of Important Review Findings (first half of table) – ONLINE ONLY

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Reference, Year, Location / Setting / Participants / Training, Impact
Alamo et al., 2002, 2001, Spain55, 56 / Type: Health centers; #:13; Funding: federal; IRB: NR but informed consent / Physicians (10 T, 10C); 100% recruitment rate. Patients (63T, 46C). 100% recruitment rate. Diagnosis: chronic musculosheletal pain (CMP), fibromyalgia (F). Inclusion: 18-65yrs, 1st visit for CMP/F. Exclusion: organic disease cause for pain; previously diagnosed and treated by specialist. Other: F=97.3%, ave. age 40.4 yr / 18 hrs; positive skills impact
Brown et al., 1999, USA57 / Type: HMO; #: NR; Funding: Kaiser; IRB: yes / Physicians, NP, PA (32T 29C). 6.9% recruitment rate. Patients (81/doctor); recruitment rate NR. Diagnosis: general condition. Inclusion: agreed to participate. Exclusion: None. Other: F=64%; age=30-60 years. / 10 hrs; positive skills impact
Elwyn et al., 2004,58 Edwards et al., 2004, 2003, UK59, 60 / Type: Private; #: 20; Funding: Federal; IRB: yes / Physicians (20 total) 20% recruitment rate. Patients (total 747) 28.9% recruitment rate. Diagnosis: atrial fibrillation, prostatism, mennorrhagia, menopausal symptoms Inclusion: four conditions, and attend consultation for review of their condition. Exclusion: NR. Other: F=50%; age for benign prostatic hypertrophy-63, atrial fibrillation-65, mennorrhagia-45, menopause-56. / 12 hours; positive skills impact
Joos et al., 1996, USA61 / Type: University; #: 1; Funding: VA; IRB: yes / Physicians (22T, 20C), 95% recruitment rate. Patients (209T, 191C), 73% recruitment rate. Diagnosis: chronic medical problems. Inclusion: NR; Exclusion: NR. Other: F=7%; ave age=62.3 years. / 4.5 hrs; positive skills impact.
Ockene et al., 1997, 1999, USA52, 53 / Type: University; #: 4; Funding: federal; IRB: yes / Physicians, NPs (T19, C27), 98% recruitment rate. Patients: (T274, C256), 97% recruitment rate. Diagnosis: high-risk drinkers, Inclusion: 21-70 yrs scheduled to be seen between 04/94 and 04/97. Exclusion: pregnant, planned to move within a year, no telephone, already participating in alcohol intervention, Axis I psychiatric disorder, prevented from participating, unable to complete informed consent. Other: F=35.4%; ave age=43.9 years. / 2.5 hrs; impact not evaluated.
Thom, 1999, USA62, 63 / Type: private practices; #: 20; Funding: Picker/Commonwealth fund + Bayer Institute IRB: yes / Physicians (GPs) (T10, C10), Recruitment rate 20 of 320 (6.5%). Patients: 415 T & C, recruitment=74%. Diagnosis:general medical Inclusion: practice of PCP Exclusion:<18, acute, no prior visit to doctor, not identified doctor as their doctor, illiterate. Other: F=63%; ave age=47.3yrs. / 7 hours over 1 session; negative skills impact.
Briel et al., 2006, Switzerland64 / Type: Private; #: 45; Funding: federal & pharma; IRB: yes / Physicians (GPs) (T15, C15; 15C2), Recruitment rate 13%. Patients: (T259, C293; dummy 285) Recruitment rate: 75.5% Diagnosis:acute URI Inclusion: >18yrs, 1st consult for URI Exclusion:pneumonia, not fluent in German, IV drugs, psych disease Other: F=57.5%; ave age=42yrs. / 10 hours: 2 hours URI guidelines to both T and C; + 6 hours PTC seminar + 2 hours telephone feedback to T only; impact not evaluated.
Chassany et al., 2006, France65 / Type: Private; #: multi-center; Funding: industry, drug company gave meds; IRB: NR / Physicians (GPs) (T84, C96), Recruitment rate12% of 1500. Patients: (T414, C428), Recruitment rate: NR, Diagnosis: osteoarthritis, Inclusion: recruited by own doc; OA and pain >40mm on VAS and indication for treatment with tylenol; >49yrs with OA on hip/knee x-ray for 6 mos. Exclusion: acute, any analgesic within 24 hours or opioid prior 2 wk or likely to need change NSAID during study or had begun AD 2 within mos or likely to need change in dose or received steroids in 2 mo or surg in 3 mo or recent other treatment. Other: F=64.5%; ave age=69yrs. / 4 hours (2 trainers, 36 docs; small discussion groups of 6); 8 reminders post-training; impact not evaluated.
Alder et al., 2007, Switzerland66 / Type: Private; #: 1; Funding: Swiss national fund; IRB: yes / Physicians (OB-GYN faculty & residents) (T16, C16), Recruitment rate 100%. Patients: (T44, C64), Recruitment rate: NR. Diagnosis: general OB. Inclusion: NR; Exclusion: NR. Other: F=NR; ave age=NR. / ~26 hours over 3 months: (1-day workshop theoretical background; 3 half-day practice seminars; 5-6 1-hr supervision); negative skills impact: 6 trained, blinded independent raters evaluated videotapes of physician patient interactions at T1 and T2 (p=NS).
Evans et al., 1987, UK67 / Type: Private; #: NR; Funding: NR; IRB: NR / Physicians (20T 20C). Recruitment rate15.9%. Patients (200T, 200C), recruitment rate NR. Diagnosis: general medical problems. Inclusion: NR; Exclusion: NR. Other: F=55%; ave age=42.1 years. / 6 hours; impact not evaluated.
Williams and Deci, 2001, USA54 / Type: Community physicians affiliated with University; #: Many sites; Funding: federal; IRB: yes / Physicians (27 total); recruitment NA. Patients (316 ITT, 249 as treated); 94% recruitment rate. Diagnosis: smokers. Inclusion: adults, 5 cigarettes/day, agreed to participate. Exclusion: NR. Other: F=62%; ave age=43.2 years. / 3 hours; impact not evaluated.
Smith et al., 2006, USA43 / Type: HMO; #: 1; Funding: federal; IRB: yes / Nurse practitioners (T4, C21 HMO physicians), Recruitment rate NA. Patients: (101T, 105C) 56.3% recruitment rate. Diagnosis: Medically Unexplained Symptoms. Inclusion: high utilizing (for preceding 2 years),18-65 years old, English-speaking, literate, not under care by MH professional, access to telephone, plan to be in HMO for at least 1 year. Exclusion: pregnancy, substance abuse, suicidal ideation, organic mental syndromes, psychosis. Other: F=82%; ave age=47.7 years. / 84 hrs over 10 weeks; impact not evaluated but refer to positive prior results with less intense training
Feinberg, 1992, USA68 / Type: University; #: 1; Funding: federal (dissertation); IRB: NR / Occupational therapist (with special training in Rheumatology), Recruitment rate NA. Patients: (T20, C20), Recruitment rate: 100%, 87% retained. Diagnosis: rheumatoid arthritis Inclusion: RA class I-II, oupatients, no prior splints, all at referral for splinting. Exclusion: not given Other: mostly married females; ave age 48.8yrs. / No training.
#=number; AD=antidepressant; Ave=average; C=control; DPR=doctor-patient relationship; ES=effect size; F=female; GP=general practitioner; HMO=health maintenance organization; IRB=institutional review board; ITT=intention to treat; MH=mental health; NA=not applicable; NP=nurse practitioner; NS=not significant; T=treatment; wk=week; mo=month


Summary Table. Summary of Important Review Findings (continued) – ONLINE ONLY

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Reference, Year, Location / Intervention,
Intensity,
Controls / Methods/Quality / Measures and Patient Outcome
Alamo et al., 2002, 2001, 2001, Spain / Description: 15 features listed on prompt card: i) listen; ii) ask about symptoms in general; iii) ask for concerns/fears; iv) ask explanatory model; v) ask expectations; vi) provide support and empathy; vii) reassure re benignity; viii) offer help; ix) clear information; x) encourage questions; xi) share decisions; xii) negotiate aggreement; xiii) name condition; xiv) don't interrupt; xv) offer availability. Intensity: 1 visit baseline, 2 and 12 months. Control: usual care. / Random: Doctors randomized, no details; Blinded: Outcome assessors blinded; UOAE: not acknowledged; ITT: yes; Power: needed 126 pts to detect 1 point diff on VAS (clinically significant). / Primary end-point: Reduction in intensity pain via VAS and pain scale of Nottingham profile at 12 mo: Treatment patients 1 point better on VAS; P=.14 Secondary/endpoint: data sheet extraction of pain characterisitcs and other measures: # associated symptoms, # tender points, subjective health status, psychological disturbance via Goldberg anxiety/depression scale: only number of tender points (p=.04) and anxiety (P=.05) improved; Fidelity: telephone call to patients to determine if doctor patient-centered. Mechanism: NA
NEGATIVE STUDY BUT HAS DECREASED POWER
Brown et al., 1999, USA / Description: build DPR, active listening, respond to feelings, provide respect & understanding. Intensity: NR (likely minutes). Control: usual care. / Random: Doctors randomized via random number table; Blinded: NR for outcome assessors; UOAE: not acknowledged; ITT: no; Power: >0.8, p 0.05 one sided for 25% improved score. / Primary end-point: mean difference score on Art of Medicine survey within 10 days of visit re. doctor's: i) courtesy/respect; ii) understanding; iii) explanations; iv) listening; v) spending enough time; and regarding patient's vi) understanding of doctor; vii) confidence in doctor; viii) overall satisfaction. P=NS on all measures. Secondary outcomes - none. Fidelity - no data. Mechanism: NA
NEGATIVE STUDY

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Elwyn et al., 2004, Edwards et al., 2004, 2003, UK / Description: 2 well-defined SDM workshops, second workshop involved consultation with standardized patients with feedback. Compared with risk communication aides. Intensity - 1 visit. Control: usual care. / Random: Doctors randomized and patients randomized within cluster; random number generator; Blinded: NR; UOAE: addressed; ITT: no; Power: need 960 patients to detect 20% change in score with power 0.80, 2 sided. / Primary endpoint: No significant change beteen SDM and RC conditions one month post-encounter in patients' satisfaction, confidence in decisions, or risk communication. Secondary end-point all=NS: 1) Spielberger, 2) Enablement, 3) SF-12, 4) Satisfaction, 5) Compliance, 6) Perceived support. Fidelity no data. Mechanism: NA
NEGATIVE STUDY BUT HAS DECREASED POWER
Joos et al., 1996, USA / Description: Elicit patient concerns using Patient Request for Services questionnaire (16-items): information about disease condition and treatment, counseling regarding habit and behavior change, dicussion of their concerns with doctor, assistance with emotional and social problems, tests and referrals to specialists Intensity-1 visit. Control: usual care. / Random: Doctors randomized, no details; Blinded: NR for outcome assessors; UOAE: addressed; ITT: no; Power: NR. / Primary endpoint: i) Patient perception of amount of information received about disease (p=.04) and meds (p=.06); ii) patient satisfaction (p=NS). iii) patient compliance with medications using combination of computerized pharmacy records and patient interview 3 months after baseline and postintervention visits (p=NS). iv) Patient compliance with visits - computerized appointment files-all outpatient clinics 1 year before and after intervention (p<0.05 but not clinically significant). Secondary endpoint: None. Fidelity: frequency with which physicians elicited all patient concerns increased in T vs.C (p=0.03). No difference in frequency of any category of doctor or patient utterances, including total number of utterances.. Mechanism: not discussed
MINIMALLY POSITIVE STUDY

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Ockene et al., 1999, USA / Description: Motivational interviewing - 3E = Express concern, Explore concern, Encourage motivation. 1) Personalize survey results/Assess current drinking. 2) Advise sensible drinking limits 3) Assess understanding, concern. 4) Assess / facilitate 5) Problem solve. 6) complete goal statement. Intensity: one 5-10 minute visit. Control: usual care + received booklet on general heatlh. / Random: Practices randomized, random number generator; Blind: yes; UOAE: addressed; ITT: NR; Power: to detect clinically significant difference of at least 2 drinks/week. / Primary endpoint: Alcohol consumption was significantly reduced after 6 months (p=0.001). Adjusted for age, sex, baseline alcohol usage. Secondary endpoint : none. Fidelity: not done. Mechanism: not discussed
POSITIVE STUDY
Thom, 1999, USA / Description: Evaluate problems, understand patient expectations, caring, give treatment, communicate well, build partnership, be honest, give respect; based on Bayer Workshop models. Intensity: 1 visit only. Control: usual care. / Random: Doctors randomized, random number table; Blind: NR for outcome assessors:NR; UOAE: yes; ITT: NR; Power: of 0.8 to detect 5 point difference on 0 - 100 scale for trust and satisfaction. / Primary endpoint: 0, 1, 6 months patient satisfaction, adherence, and utilization (P=NS). Fidelity: NR. Mechanism: NA
NEGATIVE STUDY BUT TRAINING IMPACT WAS NEGATIVE, LIKELY IMPAIRING DEPLOYMENT OF THE INTERVENTION
Briel et al., 2006, Switzerland / Description: Evidence-based management guidelines + modify patient’s belief for antibiotic use, active listening, respond to emotional cues and tailor information to patient needs. Intensity: 1 visit only. Control: received only evidence-based guidelines; also had dummy control with only usual care. / Random: Doctors randomized, no details; Blind: Outcome assessors blinded; UOAE: not acknowledged; ITT: yes; Power: of 0.9 to detect 20% difference in antibiotic treatment and 50% prescription rate in limited intervention group. / Primary endpoint: No significant difference in antibiotic use at 2 weeks. Secondary endpoints: a) patient satisfaction = NS; b) patient enablement = NS; c) reconsultation =NS; d) days off work = NS; Fidelity: no data; Mechanism: NA
NEGATIVE STUDY BUT NO EVALUATION OF TRAINING IMPACT OR FIDELITY TO THE INTERVENTION

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Chassany et al., 2006, France / Description: Believe pain genuine; explain mechanism; reassure; likely result; need treatment with tylenol; say all they want to doctor; partnership; negotiate contract. Other treatment : tylenol as prescribed by doctor. Intensity: one visit. Control: usual care. / Random: Doctors randomized, no details; Blind: NR; UOAE: not acknowledged; ITT: yes; Power: need 800 subjects to detect 5mm change in pain intensity difference measure. / Primary endpoint: Pain intensity difference score @ 2 weeks on motion in 316T vs 265C: diff = 59.0; p<0.001; adjusted for tylenol use, p<0.001. Secondary endpoints: sum of pain intensity difference: -4.5; p<0.01; osteoarthritis index p<0.001; functional disability, p<0.001; Fidelity: NR. Mechanism: not discussed
POSITIVE STUDY BUT RECRUITMENT OF 12% RESTRICTS GENERALIZABILITY
Alder et al., 2007, Switzerland / Description: Patient-centered: establish therapeutic relationship, understand problem, give information, educate patient, SDM (41 substeps) Other treatment : NR. Intensity: 1 visit. Control: usual care. / Random: Doctors randomized and stratified by gender and faculty status, details not given; Blind: Outcome assessors blinded; UOAE: addressed; ITT: yes; Power: to detect pre-post intervention differences (alpha 0.05, power 0.8) in patient satisfaction and in change of communication skills / Primary endpoint: 4 scales of patient satisfaction = NS. Physicians with poorer performance at the beginning showed greater improvements over course of study; Fidelity: see training impact. Mechanism: NA.
NEGATIVE STUDY BUT TRAINING IMPACT WAS NEGATIVE, LIKELY IMPAIRING DEPLOYMENT OF THE INTERVENTION

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Evans et al., 1987, UK / Description: Booklet (from Dr. Peter Maguire) addressed satisfaction, compliance, recall, understanding + technical skills to implement interaction skills. Intensity: NR (likely minimal). Control: usual care. / Random: Doctors randomized, no details; Blinded: Outcome assessors blinded; UOAE: NR; ITT: no; Power: NR. / Primary end-point: Not specified, but likely post consultation reduction in patient anxiety using Spielberger: Treatment group had higher trait anxiety (p<0.001), lower state anxiety (p<0.001). Secondary end-point: Doctor-Patient Communication survey: Treatment improved post-consultation satisfaction on all 17 questions (p<0.001). Fidelity no data. Mechanism: not discussed.
POSITIVE STUDY BUT RECRUITMENT OF 15.9% RESTRICTS GENERALIZABILITY
Williams and Deci, 2001, USA / Description: Treatment: autonomy via 4A program: Ask about smoking and concerns; Advise while acknowledging patient choice; Assist if patient ready Acknowledge and encourage if not; follow-up. Intensity-1 visit, 11 minutes. Control: directive counseling. / Random: Patients randomized, no details; Blinded: Outcome assessment blinded; UOAE: NA; ITT: yes; Power: NR. / Primary end-point:smoking cessation at 6 months, 12 months, 30 months. Intervention did not have direct effect on cessation. Secondary: None Fidelity: audiotapes verified use of 4 As: Mean rated autonomy support was significantly greater in trained group: 77.2 vs. 58.1, p=0.00. Mechanism: Treatment led to increased patient active involvement, which led to decreased smoking, as hypothesized, which applied to 6, 12, 30 mos and continuous cessation
POSITIVE STUDY

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