Psychosexual problems in general practice: measuring consultation competence using two different measures

Abstract

BACKGROUND: Psychosexual problems are a common presentation in general practice. Given that the cornerstone of assessment is excellent consultations skills, it may be assumed that general practitioners (GPs) will perform skilfully for such presentations. AIM: To determine if there is a significant difference in consultation skills assessed using a generic test of consultation performance compared to one which has been specifically developed for experts in psychosexual care, albeit modified for general practice consultations. METHODS: Six GPs were video recorded consulting six standardised patients at their respective practices. Two assessors independently rated the consultation performance using the Leicester Assessment Package (LAP), a generic tool to assess GP consultation performance. Four sexologists, blind to the review by the LAP assessors, assessed the same consultations deploying the Permission, Limited Information, Specific Suggestion, Intensive Therapy (PLISSIT) framework. The PLISSIT is routinely used to teach health professionals communication skills when consulting people with psychosexual problems.RESULTS: Thirty-four consultations were successfully recorded. The mean duration of consultations was 12 minutes and 10 seconds (range 7 m. 54 s. to 16 m. 54 s.). Three GPs differed significantly in core competencies as measured by the LAP. Similarly, three GPs differed in competencies as measured by the PLISSIT. There were significant differences in mean LAP scores and PLISSIT scores observed for different doctors. Mean LAP scores varied by actor-scenario after adjusting for doctor clustering, whereas PLISSIT scoring did not vary significantly by actor-scenario in this small study with limited power. There was no evidence that mean LAP scores were associated with PLISSIT scores. CONCLUSIONS: Two measures of consultation competence revealed different outcomes when applied to the same consultations. We found evidence that general practitioners vary significantly on different measures of consultation competence when consulting patients with psychosexual problems in the context of a cancer diagnosis.