Second Citizens' Panel report
Second Panel Report
The second Citizens' Panel survey asked for members' views on loneliness in Scotland and shared decision-making with health and social care professionals. The survey was carried out between March and May 2017 and covered the following issues:
- How loneliness affects people in Scotland
- Our relationships with health and social care professionals
- Shared decision-making
- How well services are working locally
A good consultation
The first section of the questionnaire asked Panel members about the different things that they feel provide the ingredients for a ‘good doctor’, and on a similar theme, what things combine to make a ‘good consultation’ with a doctor. The open-ended responses provided to this question were coded into common themes. Over 6 in 10 comments (64%) were where Panel members described a ‘good doctor’ as being knowledgeable or qualified. A further 59% of respondents commented they should be a ‘good listener’, 38% felt they should be friendly or approachable and 31% said a good doctor should be caring and show empathy.
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Publication date: August 2017
As a follow up to this question, respondents were asked about the elements they think are most important for a ‘good consultation’ with a doctor. Again, the open-ended responses have been coded into common themes for analysis purposes. Two thirds of these individuals believed that it was important that a ‘good consultation’ with a doctor resulted in being provided with clear information (67%) and 76% felt it was important to feel that they have been listened to and were given sufficient time to speak to their doctor.
Making decisions together
This section of the survey aimed to find out how Panel members currently make decisions about their health, care and treatment.
All respondents were asked whether they have asked their doctor about a range of issues. Two thirds were in agreement that they have indeed asked their doctor about their treatment or care options (67%) and 64% have asked their doctor about the possible benefits and risks of their treatment or care options. Fewer respondents have asked their doctor about how likely the benefits and risks of each option are to happen to them (54%).
Following on from this, all respondents were asked about how comfortable they would feel asking their doctor about a range of different things regarding their treatment or care options. Respondents were most likely to feel comfortable asking their doctor about their treatment or care options (92%), and about the possible benefits and risks of those options (91%).
On the other hand, only 35% of survey respondents said they would feel comfortable asking to speak to another doctor compared to 41% who said they would feel uncomfortable.
Only 13% of survey respondents said there were other questions they would like to ask their doctor to help them make decisions about their healthcare and treatment. The comments provided were of a varied and personal nature. However, the main themes emerging from these comments were where respondents were interested in alternative treatment options and regarding follow-up care and next steps.
Talking to a doctor
This section of the questionnaire focused on understanding what is important to Panel members when talking to their doctor.
Respondents were asked to describe any personal aspects of their life that they feel it is important to discuss when talking about their healthcare preferences with a doctor. The open-ended comments were coded into common themes and revealed that the top three factors perceived as being most important for Panel members when talking about their healthcare preferences with a doctor were family circumstances (33%), general health (29%) and lifestyle or quality of life (30%).
An open-ended question was included in the questionnaire which asked Panel members what information would help them make a decision about care and treatment when talking to a doctor. Just under half of respondents (48%) said that understanding the side effects or risks of their medication or treatment would be beneficial and 46% said that being properly informed to make decisions, being given a clear diagnosis or an honest opinion from their doctor would help them to make decisions.
Only 15% of survey respondents were of the opinion that there are things that stop (or limit) them from being involved in decisions about their healthcare and treatment. The vast majority (74%) said this was not the case, 9% were unsure and 3% said this was not applicable.
A total of 75 respondents (out of 79 who answered yes to the question above), provided details of the things that stop (or limit) them from being involved in decisions about their healthcare and treatment. The main themes emerging from these comments were:
- not having sufficient time with doctor
- having insufficient knowledge of treatment options to question anything
- doctor knows best/don’t like to question them
- doctor doesn’t listen to me/not approachable o lack of confidence in asking questions, and
- mental health issues (e.g. depression, anxiety etc).
Talking to other Health and Care professionals
The aim of this section was to understand how comfortable Panel members would feel talking to these other health and care professionals about their healthcare needs.
In terms of other service professionals it was clear that people felt most comfortable asking a nurse (e.g. community nurse, midwife, GP practice nurse etc) about their treatment or care options with 91% stating they felt comfortable or very comfortable doing this. On the other hand, respondents felt less comfortable asking social care professionals (66%) and other service professionals such as counsellors or support staff (65%) about their treatment or care options.
Following on from this, respondents were asked how comfortable people felt asking other service professionals about the benefits and risks of their treatment and care options. Again, respondents felt most comfortable asking a nurse for this type of advice (90%). Respondents were least comfortable asking for this advice from a social care professional (66%) or other service professional such as a counsellor or support staff (66%).
Just under 9 in 10 respondents (89%) said they would feel comfortable or very comfortable asking a nurse about how likely the benefits and risks of each option were. Respondents were less comfortable asking other service professionals such as counsellors or support staff (66%) and social care professionals (65%) about the likelihood of the benefits and risks happening to them.
Panel members were asked about the forms of information they prefer to receive, to help them make decisions about their healthcare.
Face-to-face consultations were by far and away the most preferred way of obtaining information about healthcare needs with 82% of respondents stating they would prefer a face-to-face consultation with a doctor and a further 46% preferring a face-to-face consultation with a nurse. Over 3 in 10 respondents preferred a phone consultation (31%) and 30% preferred information to be provided in leaflet form.
Social isolation and loneliness
The aim of this section of the questionnaire was to find out how common feelings of loneliness are amongst the general public in Scotland and to seek views about ways to address loneliness.
The questionnaire included an open-ended response which asked respondents what ‘loneliness’ means personally to them. The majority of these comments were where Panel members said that loneliness to them meant having no family or friends to talk to (61%) and a further 19% stated it was a lack of social interaction.
All respondents were asked how often they have been feeling certain ways over the last month. These questions are from The UCLA 3-Item Loneliness Scale2 . This scale is often provided in self-completion surveys and is an individualistic scale that allows us to measure the extent to which an individual feels lonely.
The scores for each individual question can be added together to give a possible range of scores from 3 to 9 (using a scale where 1=never or hardly ever, 2=some of the time and 3=often). Scores between 3 and 7 can be identified as people who are “not lonely” and people with a score of 8 or 9 are identified as “often lonely”. Using this scoring system for all respondents, 10% were identified as being often lonely and 90% not lonely.
Following on from this, respondents were asked to what extent they agreed or disagreed with three statements about their relationships. The vast majority were in agreement that:
- they have enough people they feel comfortable asking for help at any time (76% either agreeing or agreeing strongly with this statement)
- they are content with friendships and relationships (73%), and
- their relationships are as satisfying as they would want them to be (66%).
An open-ended question was included in the questionnaire which asked respondents what they believed to be the main cause of loneliness. Over 4 in 10 of these comments were where respondents commented that the main cause of loneliness was due to a lack of social interactions or where people did not have someone to talk to (41%). A further 18% felt anxiety, depression and mental health issues was the main cause of loneliness, 16% said it was due to family and friends moving away or due to isolation and people being alone (16%).
Respondents were then asked what they felt could be done to reduce loneliness in Scotland. The main themes were where respondents felt that more should be done to encourage people to socialise (22%), groups and activities should be available for people of all ages (22%) and strong community groups and support would help to reduce loneliness (21%).
What happens near you?
The final section of the questionnaire asked Panel members, in relation to health and social care in Scotland, what they feel is being done well where they live and about anything which would benefit from improvements or changes to service delivery.
In terms of what Panel members believe health and/or social care services are doing well in the area they live the top responses were good GP services (29%) and that health and social care services are doing everything well or the best they can (30%).
When asked about the things that health and/or social care services could do better, one in four comments were regarding the availability of GP or nurse appointments (25%), 15% commented on staffing or resourcing issues and 11% mentioned improvements needed to mental health services.
Findings from the survey are being used by the Chief Medical Office to inform its ongoing service improvement and policy development on Realistic Medicine, including the Scottish Government’s health literacy action plan 2017-2025. Feedback from Panel members was included in the Chief Medical Officer’s 2016-17 annual report, Practicing Realistic Medicine.
The results have also been useful to a range of voluntary organisations, contributing a valuable public perspective to the debates around loneliness and isolation. Results are included in the Scottish Government’s national strategy, A Connected Scotland: Tackling social isolation and loneliness and building stronger communities.