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How can I collect feedback when my patients are too unwell to respond?

This case study will help if you:

  • work in palliative care, or
  • have patients who are children or young people
  • have patients with reduced capacity
  • have patients who may be distressed
  • see a small number of patients with repeated contact.

Key points to consider

  • You need to collect and reflect on patient feedback for revalidation, whatever your role or specialty. If you see a small number of patients, or patients who may find it difficult to give you feedback, you should still collect patient feedback and consider how best you can do this.
  • If your patients are children, or have learning disabilities or communication difficulties, adjust the feedback process so they can participate. For example, by offering support to feedback (independent of you) or using an easy read questionnaire.
  • If your patient can’t give you feedback themselves, use a proxy, such as a member of the patient’s family or their carer, on their behalf.
  • If your patients or their proxy are too distressed to be asked for feedback, think about whether you could ask at a later time.
  • Make sure those you ask for feedback understand why you’re asking for feedback and how you’ll use it. Clearly explaining this means they’re more likely to respond.

Scenario

Dr Levy works as part of a small team of doctors in a hospice for children and young adults. The doctors who are in her team are part time, have a variety of backgrounds such as general practice and paediatrics, and work partly or wholly for the hospice.

Only a small number of patients are accepted at any one time so she often sees the same patients and families over a long period of time. This can lead to feedback fatigue among the patients and families, particularly as many of the patients have limited or no capacity to give their doctor feedback.

Meeting our feedback requirements

Dr Levy decided to send questionnaires by post, rather than handing them out to her patients face to face. This meant families facing difficult circumstances could complete the feedback in their own time.

She gave administrative staff at the hospice a list of patients and families she had seen. They managed the feedback process, to make sure no family was overburdened by being approached multiple times.

A covering letter to explain the process and a photograph of the doctor was provided with the form to help with recognition. They asked respondents to give free text comments, as specific examples tended to offer more helpful learning opportunities than scores alone.

She used a version of the GMC questionnaire, adapted to make it more suitable for the hospice population and for patients’ parents and carers to use. The hospice also developed an easy read questionnaire for children and patients with learning disabilities.

If patients completed this questionnaire while at the hospice, a member of staff (other than the doctor) supported them. This was an intensive process, but made sure the feedback sample was representative of all patients.

She decided not to seek feedback via questionnaires from families after bereavement, but offered these families the opportunity to give feedback through user groups, Facebook groups, response cards and questionnaires in family flats.

While not specific to the doctor, information from these was shared with the whole team as it provided helpful learning and development opportunities.

She received an anonymised, personalised report to use at her annual appraisal, based on the questionnaires which had been returned directly to the administrator.

It took Dr Levy around three months to collect enough responses, due to the relatively small number of patients who she could approach for feedback.

However, the approach employed was far more successful than handing out forms face to face and around three quarters of the questionnaires were completed and returned.

This gave each doctor in Dr Levy’s team between 10 and 20 responses. It was a significant but achievable undertaking for this healthcare context.

Useful links

Royal College of Physicians, Physician specialty resources

Association of Palliative Medicine, Revalidation guidance

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