The author discusses the recent focus on the need for patient engagement in health care, specifically the need for patients to play an active role in their own health care. Patients should be fully informed about their health care and work with their provider to make the decision that is right for them. The author discusses how health literacy, shared decision making and quality improvement are all related to the concept of patient engagement. The author also focuses on evidence in support of interventions designed to engage patients in their health care.
Nothing about me without me was the guiding principle adopted by 64 participants from 29 countries at a 1998 Salzburg Global Seminar convened to develop ideas for improving the quality of health care by involving patients. The catchphrase has now resurfaced in the coalition governments new plan for the NHS in England, which sees patient choice and shared decision making as key mechanisms to create a patient centred and quality focused NHS.
Policies to promote shared decision making are becoming prominent in the United States, Canada, and United Kingdom. This is partly because of a recognition of the ethical imperative to properly involve patients in decisions about their care and partly because of the acrruing evidence that the approach has benefits. Shared decision making is an approach where clinicians and patients make decisions together using the best available evidence.
Posted in Health Care Policy, Patient Involvement, SDM Implementation
Tagged Angela Coulter, decision-making, evidence-based medicine, Glyn Elwyn, NHS, patient autonomy, patient engagement, patients, shared decision making
There is much evidence that engaging patients in treatment decisions and supporting their efforts at self-care can lead to beneficial outcomes. Patients who are active participants in a shared decision-making process have a better knowledge of treatment options and more realistic perceptions of likely treatment effects. The resulting treatment choices are more likely to concur with their preferences and attitudes to risk. Actively engaged patients are also more likely to adhere to treatment recommendations, and less likely to select expensive procedures. However, patients' desires to play and active role in decision making varies, and, according to Cox et al., GPs are not very good at predicting what role patients want to play. What should be done about this problem?
Policymakers increasingly believe that encouraging patients to play a more active role in their health care could improve quality, efficiency, and health outcomes. But critics have dismissed talk about patient engagement and patient centred care as political correctness -- a misplaced concern with the "touchy feely" aspects of health care, with no scientific basis and little relevance to the quest for excellence in clinical care. Who is right? To what extent is the planned shift towards greater patient engagement supported by robust research evidence?
Good quality health information is essential for greater patient involvement in healthcare. Patients and the public require information that is timely, relevant, reliable and easy to understand. This is an essential component of any strategy to promote health literacy, self-care, choice- shared decision-making, medication adherence and self-management of chronic disease. Patients have many decisions to make about their healthcare and, like all decision-makers, they require information to inform their choices. Reliable information is also essential to help patients understand their health problems and how to deal with them.
Patient-focused interventions are those that recognise the role of patients as active participants in the process of securing appropriate, effective, safe and responsive healthcare. There is a growing belief among policy-makers that patients/citizens can contribute to quality improvement at both an individual and a collective level.
Most patients want to play an active role in their own healthcare. They want to know how to protect and improve their health when they are well; when they are ill they want information about the treatment options and likely outcomes; and, in addition to seeking fast effective health advice and care when they need it, most people also want to know what they can do to help themselves.
Posted in Health Care Policy, Patient Involvement, Patient Knowledge, Patient Satisfaction, SDM Implementation
Tagged Angela Coulter, doctor-patient communication, health care, health policy, informed choice, patient engagement, patient participation, Picker Institute Europe, UK
The traditional style of medical decision-making in which doctors take sole responsibility for treatment decisions is being challenged. Attempts are being made to promote shared decision-making in which patients are given the opportunity to express their values and preferences and to participate in decisions about their care. Critics of shared decision-making argue that most patients do not want to participate in decisions; that revealing the uncertainties inherent in medical care could be harmful; that it is not feasible to provide information about the potential risks and benefits of all treatment options; and that increasing patient involvement in decision-making will lead to greater demand for unnecessary, costly or harmful procedures which could undermine the equitable allocation of health care resources.
Posted in Patient Decision Aids, Patient Involvement, Patient Preferences
Tagged Angela Coulter, decision support, decision-making, health care, informed decisions, patient engagement, patient participation, patients, shared decision making, treatment decisions
This short article outlines the history of patient-centered care, the importance of involving patients in decisions where there is more than one reasonable option and the practice of shared decision making, and argues for their increased use.