Evidence-based clinical encounter vignettes facilitate data collection

Creating content for deliberative dialogues

We sought a novel way to describe our interview findings, rather than sharing themes in a standard academic presentation. We chose to create vignettes describing fictional patient-FP encounters that represented our findings, thereby creating an environment in which patients and FPs had the opportunity to place themselves within patient-FP encounters. Together, they could then share ways the encounters did or did not represent compassionate care. The vignettes were made using voiceover narration by the research team within Microsoft PowerPoint slides, with cartoon depictions of the characters from publicly accessible websites; no artificial intelligence was used. We created 3 vignettes, 1 representing an in-person visit and 2 representing virtual visits, each highlighting different aspects of the interview findings. We situated these vignettes within the same fictitious patient-FP dyad to illustrate the ebb and flow of the patient-FP relationship. We wanted to avoid participants believing they needed to judge different fictitious FPs as “good” or “bad,” instead focusing on the behaviour within the encounters.

Conducting the deliberative dialogues

We conducted deliberative dialogues at Western University in London, Ont, over the Zoom platform, with 6 patient participants and 4 FP participants across 3 dialogues, lasting on average 2.5 hours. In 2 deliberative dialogue sessions, there was 1 FP and 2 patients, but in the other, there were 2 FPs and 2 patients. We recruited both new patients and FPs and those who participated in the earlier phase of the project and indicated a willingness to be contacted for future research. Before each dialogue, participants were provided with vignette scripts so they could follow along, which was helpful for anyone struggling to hear during the session. Each session started with an overview of the study, the purpose of the dialogue, and an introduction to our fictitious patient and FP. Each vignette was played, with guiding questions asked after each video: “Where did you see compassionate care in the vignette?” and “Were there places where you saw a lack of compassion?” The facilitator (B.L.R.) paid attention to group processes, alternating who started first, and encouraging participants who did not speak often to share their thoughts. Participants demonstrated respect and encouragement to each other, often through referencing and building on each other’s comments.

Reflections and future uses for deliberative dialogues

Deliberative dialogues, using simply formatted evidence-based vignettes, were an effective tool for this study. Our dialogues brought patients and FPs together to discuss our research question and engage in meaningful conversations. The strength of our deliberative dialogues is similar to that of focus groups, which allow individuals to share their experiences in the context of others’ experiences.^9,10 However, such dialogues differ from focus groups, which often bring together participants with comparable backgrounds¹; in this instance, deliberative dialogues brought together 2 key stakeholder groups—patients and FPs—who offer different perspectives. These differences meant that the dialogues acted as a form of knowledge translation¹¹ as well as data collection. Unprompted by us, participants shared how they appreciated the opportunity to reflect on their own experiences, especially enjoying having patients and FPs together and hearing each other’s perspectives, which they described as an unusual opportunity. While perspectives varied, there were no conflicting opinions voiced during the deliberative dialogues. However, interview findings were supplemented by the deliberative dialogues; this was seen when 1 participant extended and framed listening as the FP’s response to patient cues.⁸ We also found that incorporating new participants with those who had contributed in the earlier phase of the study was an opportunity to reflect on the findings from the first phase and build upon them.

A key strength of our deliberative dialogues is the use of vignettes to demonstrate our findings, using a format resonant to patients and FPs: the clinical encounter. Our participants reflected on the vignettes as a way to engage with other participants in the dialogue. This is consistent with a study by O’Brien et al,⁴ which found a similar approach successful in co-creating care recommendations. We used a low-resource technology that proved effective with our participants. This is an accessible technology that can be used even when resources are limited.

Our use of deliberative dialogues for research and knowledge translation, despite their strengths, presented recruitment challenges. Similar to focus groups, it is important to pay attention to group composition and the power dynamics at play.¹² To manage this power differential, we attempted to have more patient than FP participants for each dialogue, but coordinating participants’ schedules did not permit this for all dialogues. This was further complicated by the substantial time commitment required of the participants and coordinating a time that worked among different schedules.

Our findings demonstrate that using evidence-based clinical encounter vignettes within a deliberative dialogue format can be an effective tool in family medicine research to bring together patient and FP perspectives.