Remote discussion of emotional symptoms in telephone versus face-to-face primary care consultations: A pilot study

Background: Mental health problems, such as anxiety and depression, are very common, and may have increased as a result of the COVID pandemic and lockdown. GPs and nurses have switched many of their consultations with patients to telephone calls because of the risk of passing on the virus in face-to-face consultations. This is safer in terms of the risk of infection, but might have made it more difficult for patients to discuss any mental health problems they have been experiencing, and more difficult for the doctor or nurse to pick up anxiety and depression and offer help, advice or treatment.

Aim(s) of the research: To explore how patients with possible symptoms or concerns about mental health (for example, stress, anxiety, depression) raise their problems for discussion, in consultations sought for reasons other than mental health, and compare the extent to which clinicians pick-up on these symptoms/concerns during telephone and face-to-face consultations. We aim to recruit adult patients and both GPs and nurses to help us with our research.
Design and methods used: We will first interview 10-20 clinicians and 15-25 patients, to understand their experiences of seeking medical help or providing care, on the telephone and face-to-face, about mental health problems, and ask them about their views about any communication barriers that might be affecting their discussions. We will also ask 5-7 clinicians to record a small number of their telephone and face-to-face consultations to explore how patients raise possible symptoms/concerns about mental health, and whether clinicians pick up on these concerns and discuss them with the patient. We will analyse the data using Conversation Analysis which is a well-established method for understanding communication.

Patient and public involvement: Two patient and public contributors are involved in this research. They have provided verbal and written feedback on this application to make sure the topic is important and the research objectives are clear. They will both be involved in team meetings, reviewing patient documents and helping us with our analyses over the course of the 12 months of the project.

Dissemination: We want to use the findings to improve the delivery of care for mental health problems to ensure patients are getting the help that they need and clinicians feel able to provide it. We aim to publish two papers from this research and use the findings to design a larger study in the future to develop and test communication resources for patients and/or training for clinicians to improve consultations involving new mental health symptoms.

Amount awarded: £32,032