Table 3.
Thematic analysis of the dataset
| Themes (1–21) | References | Text segment no.a |
|---|---|---|
| 1/Shared problem defining | ||
| Achieve a shared understanding [of the problems with the patient] | [19] | 9 |
| Partnership [finding common ground [..] and mutual agreement about patients’ ideas, the problem] | [20] | 51a |
| Reach agreement on problems [..] | [21] | 48a |
| Reaching a shared understanding of the problem [..] with the patient that is concordant within the patient’s values | [22] | 73a |
| Patient’s involvement in the problem-defining process | [23] | 56a |
| 2/Involve the patient in the consultation | ||
| Patient’s involvement in the problem-defining process [encouraging full expression of problem(s) and expectations of the visit] | [23] | 56b |
| Communication [listening, requirements for information] | [20] | 50b |
| Allow patients to express their major concerns | [25] | 19 |
| Relationship: let the patient talk | [24] | 30 |
| Gather information [actively listening using nonverbal and verbal techniques] | [21] | 45 |
| Explores the patient’s view by actively listening, and clarifies the reasons for help | [27] | 88 |
| Encourages the patient to respond to the questions asked[..] | [27] | 89a |
| [..] facilitation of patient disclosure | [26] | 67a |
| Partnership building [through active enlistment of patient input] | [26] | 69a |
| Invest in the beginning [show familiarity, question style, expansion of concerns, elicit full agenda] | [28] | 75 |
| 3/Explore and understand the patient’s perspective | ||
| Define the reason for attendance, including the history, the patient’s ideas, concerns and expectations, and the effects of the problem | [19] | 6 |
| Exploring both the disease and the illness experience | [32] | 13 |
| Elicit patients' explanations of their illnesses | [25] | 21 |
| Ability to elicit and discuss patients’ beliefs | [30] | 54 |
| Prior to the consultation: how has the patient prepared for the visit? [what does he/she expect] | [24] | 29 |
| Anxieties: what does the patient want? | [24] | 31 |
| Open the discussion [elicit the patient’s full set of concerns] | [21] | 44b |
| Communication [exploration of concerns] | [20] | 50c |
| Elicit the Patient’s perspective [patient’s understanding of problem, goals for visit, impact on life] | [28] | 76 |
| Eliciting and understanding the patient’s perspective: concerns, ideas, needs, feelings and functioning | [22] | 71 |
| Data gathering [..] | [26] | 67b |
| Summarizing; obtaining a sufficiently comprehensive idea of the patient’s real reason for consulting you. | [29] | 7 |
| Common language: GP’s summary. | [24] | 32 |
| Understand the patient’s perspective | [21] | 46 |
| Exchanging information [understanding what patients know and believe about health] | [31] | 80a |
| 4/Consider patient’s situation | ||
| Both the health care providerb and patient share information with each other | [33] | 26a |
| Translating: from lifeworld to world of medicine | [24] | 33 |
| Knowledge and professionalism | [34] | 95 |
| Invest in the end [give clear explanations, test for comprehension, encourage questions, use patient’s frame of reference, allow time to absorbe] | [28] | 78a |
| Encourages the patient to respond to [..] the information given, and the diagnosis | [27] | 89b |
| 5/Shared decision making | ||
| Shared decision making | [35] | 63 |
| Finding common ground regarding management | [32] | 15 |
| Both the health care provider and patient are involved (in the treatment decision-making process) | [33] | 25 |
| Interaction: negotiation on what to do | [24] | 34 |
| Sharing power and responsibility | [36] | 40 |
| [..] to active the patient to take control in the consultation [..] | [30] | 55a |
| Patient’s involvement in the decision-making process | [23] | 57 |
| Patient involvement | [35] | 61 |
| Helping patients to share power and responsibility by involving them in choices to the degree that they wish | [22] | 74 |
| Partnership [finding common ground – exploration, discussion and mutual agreement about treatment] | [20] | 51b |
| Partnership building [through active enlistment of patient input] | [26] | 69b |
| Encourages patients to actively participate in decision-making | [27] | 87 |
| 6/Inform the patient | ||
| Both the health care provider and patient share information with each other | [33] | 26b |
| Give patients information | [25] | 23 |
| Share information [use language the patient can understand, check for understanding, encourage questions] | [21] | 47 |
| Patient education [..] | [26] | 68b |
| Exchanging information [patients’ information needs, communicating clinical information] | [31] | 80b |
| Delivers and organizes information, and systematically checks that the information is well understood | [27] | 91 |
| Transparency of progress and outcome | [34] | 97 |
| Communication [clear explanation] | [20] | 50d |
| Invest in the end [give clear explanations, test for comprehension, encourage questions] | [28] | 78b |
| 7/Consider options and preferences | ||
| Both health care provider and patient take steps to participate in the decision-making process by expressing preferences | [33] | 27 |
| Advises the patient about possible treatment options and helps the patient to make choices | [27] | 90 |
| Involve patients in developing a treatment plan | [25] | 24 |
| Seek patients' specific requests | [25] | 20 |
| Exchanging information [(sharing bad news) and prognostic information] | [31] | 80c |
| Consideration of the patient’s ambivalence or self-efficacy | [23] | 59a |
| Invest in the end [explore barriers] | [28] | 78c |
| 8/Choose management plan | ||
| A treatment decision is made and both the health care provider and patient agree on the treatment to implement | [33] | 28 |
| Reach agreement on [..] plans | [21] | 48b |
| Making decisions | [31] | 81 |
| Reaching a shared understanding of the [..] treatment with the patient that is concordant within the patient’s values | [22] | 73b |
| Choose an appropriate action. [with the patient for each problem] | [19] | 8 |
| Invest in the end [involve in decisions] | [28] | 78d |
| 9/Action planning | ||
| Converting insight into action: from consultation to everyday life | [24] | 35 |
| Discusses the practicality of the therapeutic plan | [27] | 92 |
| Invest in the end [explore plan acceptability] | [28] | 78e |
| Provide closure [..], discuss follow up] | [21] | 49a |
| Invest in the end [plan for follow-up] | [28] | 78f |
| Safety-netting; planning for the unexpected | [29] | 4 |
| 10/Enable self-management | ||
| Enablement | [35] | 66 |
| Enabling patient self-management | [31] | 83 |
| Involve the patient in management. [and encourage him/her to accept appropriate responsibility] | [19] | 10 |
| Ability to active the patient to take control [..] in the management of their illness | [30] | 55b |
| Consideration of the patient’s [..] self-efficacy | [23] | 59b |
| 11/Agreement check | ||
| Agreement check: safety netting | [24] | 36 |
| Handing-over; making sure the patient is happy with the outcome of the consultation | [29] | 3 |
| Provide closure [summarize and affirm agreement with the plan of action, [..] | [21] | 49b |
| 12/Biopsychosocial perspective | ||
| Biopsychosocial perspective | [36] | 38 |
| Building a relationship [approach to care, which emphasizes both the patient’s disease and his or her illness experience] | [21] | 43a |
| [..] Biopsychosocial perspective | [35] | 64a |
| Understanding the patient within his or her unique psychosocial context | [22] | 72 |
| 13/Patient as a person | ||
| Understanding the whole person | [32] | 14 |
| Understanding the whole person | [20] | 53 |
| Holism/[..] | [35] | 64b |
| Patient-as-person | [36] | 39 |
| 14/Health promotion | ||
| Incorporating prevention and health promotion | [32] | 16 |
| Health promotion | [20] | 52 |
| Consider other problems, including continuing problems and risk factors | [19] | 7 |
| 15/The health care provider-as-person | ||
| Health care provider-as-person | [36] | 42 |
| Housekeeping; taking care of yourself | [29] | 5 |
| Leave from consultation: time for reflection | [24] | 37 |
| Building a relationship [requires an awareness that ideas, feelings, and values of [..] the health care provider influence the relationship] | [21] | 43b |
| 16/Required skills | ||
| Health care provider’s picking up the patient’s cues | [23] | 58 |
| Skills | [35] | 62 |
| Uses communication skills effectively | [27] | 86 |
| The ability to communicate | [34] | 93 |
| 17/Empathy (open to emotions) | ||
| Facilitate patients' expressions of feeling | [25] | 22 |
| [..] counseling | [26] | 68a |
| Emotionally responsive communication | [26] | 70 |
| Health care provider’s overall responsiveness to the patient | [23] | 60 |
| Demonstrate empathy [encourage emotional expression, accept feelings, identify feelings, show good nonverbal behavior] | [28] | 77 |
| Responding to emotions | [31] | 79 |
| Creates effective therapeutic relationships with patients [shows concern with patients (and families)] | [27] | 85a |
| 18/Building a relation | ||
| Connecting; achieving a working rapport with the patient; getting on the same wavelength | [29] | 1 |
| Open the discussion [establish/maintain a personal connection] | [21] | 44a |
| Establish or maintain a relationship | [19] | 12 |
| Communication [health care provider –patient relation] | [20] | 50a |
| Enhancing the health care provider-patient relationship | [32] | 17 |
| Building a relationship [requires an awareness that ideas, feelings, and values of both the patient and the health care provider influence the relationship] | [21] | 43c |
| An understanding of people and an ability to relate | [34] | 96 |
| Creates effective therapeutic relationships with patients | [27] | 85b |
| 19/Therapeutic alliance | ||
| Fostering healing relationships | [31] | 82 |
| Therapeutic alliance | [36] | 41 |
| Relation—knowing the health care provider | [35] | 65 |
| 20/Trust | ||
| Confidence | [34] | 94 |
| Managing uncertainty | [31] | 84 |
| Creates effective therapeutic relationships with patients [creates trust] | [27] | 85c |
| 21/Handling within the given context | ||
| “Being realistic” about personal limitations and issues such as the availability of time and resources | [32] | 18 |
| Use time and resources appropriately, during the consultation and long term | [19] | 11 |
a The words ‘doctor’ and ‘physician’ were replaced by ‘health care provider’ thus translating the descriptions to health care in general
b The segments of data of the articles are numbered in chronological order of publication year. Segments containing different themes are marked with a letter, e.g. 49a and 49b