On being on the same page: Predictors of gastroenterologist-patient misalignment in inflammatory bowel disease

This study explored the prevalence and degree of misalignment between gastroenterologists and people with inflammatory bowel disease (IBD) and investigated communication features related to misalignment. A mixed-methods approach incorporated qualitative and quantitative analyses of consultations and post-consultation patient and doctor interviews. Gastroenterologists at two Australian teaching hospitals and IBD patients participated in this study. Doctor-patient misalignment about topics discussed in consultations was quantified using patient and doctor interviews. Predictors of misalignment were hypothesised through a linguistic analysis of consultations and tested quantitatively. Data from 69 patients and seven gastroenterologists showed that consultation participants had different perceptions about at least one aspect of care in 36 % of the consultations. Predictors of misalignment included missing the opportunity to clarify an issue or concern and missing the opportunity to explain the rationale for a diagnosis or recommendation. Staying on the topic until the patient is ready to move on and using so-called related messages in questions and explanations increases the likelihood of doctor-patient alignment. Generic and IBD-specific clinician- and patient-targeted interventions should cover strategies for adequately discussing patients’ issues and concerns and clinicians’ clinical reasoning. These strategies should also be considered in designing health promotion activities. •1 in 3 IBD consultations led to some degree of doctor-patient misalignment.•Doctors’ use of clusters of related messages was key for building alignment.•Using related messages helped to clarify issues and rationalise recommendations.•Patients who talked about their issues early on were more aligned with their doctors.•Consultation length was not a predictor of doctor-patient alignment.