A new study published in the May issue of Health Affairs finds that some patients are concerned about being labeled “difficult” if they ask too many questions or disagree with a recommendation from their physician.
“We found that patients want to participate in making decisions with their physicians, but feel vulnerable and worried that they might be perceived as too assertive, resulting in lower quality care in the future,” says Dr. Dominick Frosch, lead author of the study.
The study was funded by a grant from the Informed Medical Decisions Foundation and was conducted by researchers at the Palo Alto Medical Foundation Research Institute and the Dartmouth Center for Health Care Delivery Science. “Research projects that look into specific barriers of shared decision making implementation are essential to ensure that the process is conducted in a way that is beneficial to both the patient and the provider,” says Dr. Michael J. Barry, president of the Informed Medical Decisions Foundation.
Dominick and colleagues conducted six focus group interviews with patients to learn more about how they perceived communicating with physicians about medical decisions. Questioning a physician’s advice or recommendations was perceived by participants as a challenge to authority that most wanted to avoid, for fear of “displeasing” or “disappointing” their physician. According to Dominick, “participants wanted their physician to be an equal partner in making decisions, but did not feel they could rely on their physician to help them understand treatment options.”
Previous studies have found that lack of physician reimbursement for shared decision making is a significant barrier, but findings from this study suggest that more needs to be done to improve patient-centered care.
“Most physicians are probably not aware that patients are concerned about asserting their preferences in a medical consultation,” says Dominick. “Our study suggests that health care providers need to be explicit with patients that their opinion matters and that it’s okay to disagree, otherwise the treatment that is prescribed may not be one the patient is willing to adhere to.”
Dominick’s team advocates for new measures of health care quality that capture the degree to which decisions made reflect patients’ informed preferences.