Patient participation

Patient participation, also called shared decision making, is "patient involvement in the decision-making process in matters pertaining to health".[1] Usually health care providers explain treatments and alternatives to patients so that patients choose the course of action most consistent with their unique personal and cultural preferences. This concept may be contrasted with the paternalistic model of medical decision making, which was prevalent until the 1990s, in which doctors told patients what to do, and the patients unquestioningly obeyed.[2] Variations of each method may be preferred by different patients.

Shared decision making combines evidence-based medicine with the preferences of patients. Some medical decisions are not strictly based on science, and patients have values that emphasize risks and benefits differently from their doctor. There is frequently more than one correct decision, and some decisions can be regarded as correct from different points of view, with the best medical interest of the patient not necessarily being regarded as the best course of action by the patient.

Shared decision making emphasizes the importance of communication in the process of making a decision and the use of decision support interventions is often advocated.

Shared decision making should be contrasted with informed consent, and simple consent.[3]

Contents

Using computers to interact with patients

Recently, interactive software or Internet websites can help interact with the patient.[4][5][6] In some studies, Internet-based interventions improve upon usual care[7] whereas in other studies interpersonal interventions are better.[8]

The quality of online decision aids is uncertain.[9] The International Patient Decision Aid Standards (IPDAS) Collaboration is a group of researchers led by professors Annette O'Connor in Canada and Glyn Elwyn in the UK working towards developing an internationally approved set of criteria to determine the quality of patient decision aids.[10] IPDAS have published a set of standards representing the efforts of more than 100 participants from 14 countries around the world.[11]

Effectiveness of patient participation

A randomized controlled trial of patients at very high risk of coronary events found that use of two clinical prediction rules (http://www.chiprehab.com/CVD/) for predicting coronary events along with tailored feedback, may improve cholesterol values.[12] In this trial, patients were also shown how their calculated risk changed over time and improved in response to changes in the patients' lifestyle changes and pharmacotherapy.

A cluster randomized controlled trial found that a cardiovascular risk calculator may reduce decisional regret.[13]

References

  1. ^ MeSH participation Patient participation
  2. ^ Buchanan A (1978). "Medical paternalism". Philos Public Aff 7 (4): 370–90. PMID 11664929. 
  3. ^ Whitney SN, McGuire AL, McCullough LB (2004). "A typology of shared decision making, informed consent, and simple consent". Ann. Intern. Med. 140 (1): 54–9. PMID 14706973. 
  4. ^ Frosch DL, Bhatnagar V, Tally S, Hamori CJ, Kaplan RM (February 2008). "Internet patient decision support: a randomized controlled trial comparing alternative approaches for men considering prostate cancer screening". Arch. Intern. Med. 168 (4): 363–9. doi:10.1001/archinternmed.2007.111. PMID 18299490. http://archinte.ama-assn.org/cgi/content/full/168/4/363. 
  5. ^ Barry MJ (2002). "Health decision aids to facilitate shared decision making in office practice". Ann. Intern. Med. 136 (2): 127–35. PMID 11790064. 
  6. ^ Kypri, Kypros; John D. Langley, John B. Saunders, Martine L. Cashell-Smith, Peter Herbison (2008-03-10). "Randomized Controlled Trial of Web-Based Alcohol Screening and Brief Intervention in Primary Care". Arch Intern Med 168 (5): 530–6. doi:10.1001/archinternmed.2007.109. PMID 18332300. http://archinte.ama-assn.org/cgi/content/abstract/168/5/530. 
  7. ^ Green, Beverly B.; Andrea J. Cook, James D. Ralston, Paul A. Fishman, Sheryl L. Catz, James Carlson, David Carrell, Lynda Tyll, Eric B. Larson, Robert S. Thompson (2008-06-25). "Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: The e-BP Randomized Controlled Trial". JAMA 299 (24): 2857–67. doi:10.1001/jama.299.24.2857. PMC 2715866. PMID 18577730. http://jama.ama-assn.org/cgi/content/abstract/299/24/2857. 
  8. ^ Svetkey LP, Stevens VJ, Brantley PJ, et al (2008). "Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial". JAMA 299 (10): 1139–48. doi:10.1001/jama.299.10.1139. PMID 18334689. http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=18334689. 
  9. ^ Levy AG, Sonnad SS, Kurichi JE, Sherman M, Armstrong K (2008). "Making Sense of Cancer Risk Calculators on the Web". J Gen Intern Med 23 (3): 229–35. doi:10.1007/s11606-007-0484-x. PMC 2359468. PMID 18188653. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2359468. 
  10. ^ http://ipdas.ohri.ca/
  11. ^ Elwyn G, O'Connor A, Stacey D, et al. (August 2006). "Developing a quality criteria framework for patient decision aids: online international Delphi consensus process". BMJ 333 (7565): 417. doi:10.1136/bmj.38926.629329.AE. PMC 1553508. PMID 16908462. http://www.bmj.com/cgi/content/full/333/7565/417. 
  12. ^ Grover SA, Lowensteyn I, Joseph L, et al. (November 2007). "Patient knowledge of coronary risk profile improves the effectiveness of dyslipidemia therapy: the CHECK-UP study: a randomized controlled trial". Arch. Intern. Med. 167 (21): 2296–303. doi:10.1001/archinte.167.21.2296. PMID 18039987. http://archinte.ama-assn.org/cgi/content/abstract/167/21/2296. 
  13. ^ Krones T, Keller H, Sönnichsen A, et al (2008). "Absolute Cardiovascular Disease Risk and Shared Decision Making in Primary Care: A Randomized Controlled Trial". Ann Fam Med 6 (3): 218–27. doi:10.1370/afm.854. PMC 2384995. PMID 18474884. http://www.annfammed.org/cgi/pmidlookup?view=long&pmid=18474884. 

See also

This article incorporates material from the Citizendium article "Patient participation", which is licensed under the Creative Commons Attribution-ShareAlike 3.0 Unported License but not under the GFDL.