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The British Journal of Psychiatry (2004) 184: 79-83
© 2004 The Royal College of Psychiatrists

Evaluation of the Two-Way Communication Checklist as a clinical intervention

Results of a multinational, randomised controlled trial

JIM VAN OS, PhD

Department of Psychiatry and Neuropsychology, European Graduate School of Neuroscience, Maastricht University, The Netherlands and Division of Psychological Medicine, Institute of Psychiatry, UK

A. CARLO ALTAMURA, PhD

Università degli Studi di Milano, Milan, Italy;

JULIO BOBES, PhD

Department of Medicine–Psychiatry, Universidad de Oviedo, Oviedo, Spain

JES GERLACH, PhD

Research Institute of Biological Psychiatry, St Hans Hospital, Roskilde, Denmark

JONATHAN S. E. HELLEWELL, PhD

Trafford General Hospital, Manchester, UK

SIEGFRIED KASPER, PhD

University Hospital for Psychiatry, Vienna, Austria

DIETER NABER, PhD

Klinik für Psychiatrie und Psychotherapie der Universität Hamburg, Hamburg, Germany

PHILIPPE ROBERT, PhD

Centre Mémoire, Clinique de Psychiatrie et de Psychologie Médicale, Hôpital Pasteur, Nice, France

Correspondence: Professor Dr Jim van Os, Department of Psychiatry and Neuropsychiatry, South Limburg Mental Health Research Network, Maastricht University, PO Box 616 (DRT10), 6200 MD Maastricht,The Netherlands.Tel: 43 3875443; fax: 43 3875444; e-mail: j.vanos{at}sp.unimaas.nl

Declaration of interest None.

Funding detailed in Acknowledgement.

Background Patients and doctors often have divergent views on care needs.

Aims To examine whether providing patients with an opportunity to identify and discuss their needs would improve communication and induce changes in care.

Method Patients with schizophrenia (n=134) were randomly allocated to either standard care or use of the Two-Way Communication Checklist (2-COM). Before seeing their clinician for a routine follow-up, participants in the active intervention group were given 2-COM, a list of 20 common needs, and told to indicate those areas they wanted to discuss with their doctor.Outcomes were assessed immediately and again after 6 weeks.

Results Using 2-COM induced a stable improvement of patient-reported quality of patient–doctor communication (B=0.33, P=0.031), and induced changes in management immediately after the intervention (OR=3.7, P=0.009; number needed to treat, 6). Treatment change was more likely inpatients with more reported needs, and needs most likely to induce treatment change displayed stronger associations with non-medication than with medication changes.

Conclusions A simple intervention to aid people in discussion of their needs results in improved communication and changes in management.




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