Patients' predispositions to discuss health issues affecting quality of life.
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BACKGROUND: Many patients are reluctant to talk to family physicians about certain health issues that affect quality of life. This research examines factors that influence a patient's willingness to discuss three aspects of health-related quality of life: overall well-being, physical health, and psychosocial health. METHODS: Prior to their consultations, 254 patients completed questionnaires that assessed their perceptions of health limitations, beliefs about the family physician's job responsibilities, willingness to discuss various topics with the physician, and relational history with the physician (ie, number of previous visits). On the post-visit instrument, patients reported whether certain topics were discussed during the consultation and their satisfaction with the physician. RESULTS: Patients were more willing to discuss all aspects of health-related quality of life when they believed it was the doctor's job to ask about these issues and when they had a longer relational history with the doctor. Patients' health limitations did not predispose patients to talk about certain issues. Patients were more satisfied with care when there was more discussion of the patient's overall well-being and physical health. However, discussions about psychosocial issues were not related to patient satisfaction. CONCLUSIONS: A theoretical model is proposed that may be useful in explaining why patients often vary in their willingness to discuss certain topics, particularly psychosocial issues. Future research should analyze how doctors and patients introduce, manage, and terminate discussions of health-related quality of life.