Patient priorities and the doorknob phenomenon in primary care: Can technology improve disclosure of patient stressors?

Objective: Patients with multiple chronic conditions face many stressors (e.g. financial, safety, transportation stressors) that are rarely prioritized for discussion with the primary care provider (PCP). In this pilot randomized controlled trial we examined the effects of a novel technology-based intervention called Customized Care on stressor disclosure. Methods: The main outcomes were stressor disclosure, patient confidence and activation, as assessed by self-report and observational methods (transcribed and coded audio-recordings of the office visit). Results: Sixty patients were enrolled. Compared with care as usual, intervention patients were 6 times more likely to disclose stressors to the PCP (OR = 6.16, 95% CI [1.53, 24.81], p = 0.011) and reported greater stressor disclosure confidence (exp[B] = 1.06, 95% CI [1.01, 1.12], p = 0.028). No differences were found in patient activation or the length of the office visit. Conclusion: Customized Care improved the likelihood of stressor disclosure without affecting the length of the PCP visit. Practice implications: Brief technology-based interventions, like Customized Care could be made available through patient portals, or on smart phones, to prime patient-PCP discussion about difficult subjects, thereby improving the patient experience and efficiency of the visit.