Patient participation: Difference between revisions
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'''Patient participation''', also called '''shared decision making''', is "patient involvement in the decision-making process in matters pertaining to health".<ref>{{MeSH|Patient participation}}</ref> | '''Patient participation''', also called '''shared decision making''', is "patient involvement in the decision-making process in matters pertaining to health".<ref>{{MeSH|Patient participation}}</ref> | ||
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; however, more recently interactive software or websites can help interact with the patient.<ref>Frosch, D. L., Bhatnagar, V., Tally, S., Hamori, C. J., & Kaplan, R. M. (2008). [http://archinte.ama-assn.org/cgi/content/full/168/4/363 Internet patient decision support: a randomized controlled trial comparing alternative approaches for men considering prostate cancer screening], Arch Intern Med, 168(4), 363-369. doi: 10.1001/archinternmed.2007.111.</ref> 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<ref>{{cite journal |author=Buchanan A |title=Medical paternalism |journal=Philos Public Aff |volume=7 |issue=4 |pages=370-90 |year=1978 |pmid=11664929}}</ref>. | 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; however, more recently interactive software or websites can help interact with the patient.<ref>Frosch, D. L., Bhatnagar, V., Tally, S., Hamori, C. J., & Kaplan, R. M. (2008). [http://archinte.ama-assn.org/cgi/content/full/168/4/363 Internet patient decision support: a randomized controlled trial comparing alternative approaches for men considering prostate cancer screening], Arch Intern Med, 168(4), 363-369. doi: 10.1001/archinternmed.2007.111.</ref><ref name="pmid11790064">{{cite journal |author=Barry MJ |title=Health decision aids to facilitate shared decision making in office practice |journal=Ann. Intern. Med. |volume=136 |issue=2 |pages=127–35 |year=2002 |pmid=11790064 |doi=}}</ref> 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<ref>{{cite journal |author=Buchanan A |title=Medical paternalism |journal=Philos Public Aff |volume=7 |issue=4 |pages=370-90 |year=1978 |pmid=11664929}}</ref>. | ||
Shared decision making combines [[evidence-based medicine]] with the preferences of patients. | Shared decision making combines [[evidence-based medicine]] with the preferences of patients.Many medical decisions are not strictly based on science. Patients have values that emphasize risks and benefits differently from their doctor. There is frequently more than one correct decision. Emerging importance of patient autonomy. Recognition of informed consent as an important component of decision making. Risk-benefit calculation renders not a single absolute recommendation but an assessment of outcome with more or less statistical certainty behind it. | ||
Shared decision making emphasizes the importance of communication in the process of making a decision. | Shared decision making emphasizes the importance of communication in the process of making a decision. | ||
==Legal | Shared decision making should be contrasted with [[informed consent]], and simple consent.<ref name="pmid14706973">{{cite journal |author=Whitney SN, McGuire AL, McCullough LB |title=A typology of shared decision making, informed consent, and simple consent |journal=Ann. Intern. Med. |volume=140 |issue=1 |pages=54–9 |year=2004 |pmid=14706973 |doi=}}</ref> | ||
==Legal rationale== | |||
Court cases such as the 1990 [[Cruzan v. Director, Missouri Department of Health]] [[Supreme Court]] case and the 1976 case of [[Karen Ann Quinlan]] have increased the importance of patient [[autonomy]] in [[medical ethics]]; shared decision making entails giving patients more influence in medical decisions. | Court cases such as the 1990 [[Cruzan v. Director, Missouri Department of Health]] [[Supreme Court]] case and the 1976 case of [[Karen Ann Quinlan]] have increased the importance of patient [[autonomy]] in [[medical ethics]]; shared decision making entails giving patients more influence in medical decisions. | ||
== | ==Effectiveness of patient participation== | ||
A [[randomized controlled trial]] of patients at very high risk of coronary events found that use of two [[clinical prediction rule]]s (http://www.chiprehab.com/CVD/) for predicting coronary events along with tailored feedback, may improve cholesterol values.<ref name="pmidpending">Steven A. Grover et al., “Patient Knowledge of Coronary Risk Profile Improves the Effectiveness of Dyslipidemia Therapy: The CHECK-UP Study: A Randomized Controlled Trial,” Arch Intern Med 167, no. 21 (November 26, 2007), http://archinte.ama-assn.org/cgi/content/abstract/167/21/2296 (accessed November 27, 2007).</ref> 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 [[randomized controlled trial]] of patients at very high risk of coronary events found that use of two [[clinical prediction rule]]s (http://www.chiprehab.com/CVD/) for predicting coronary events along with tailored feedback, may improve cholesterol values.<ref name="pmidpending">Steven A. Grover et al., “Patient Knowledge of Coronary Risk Profile Improves the Effectiveness of Dyslipidemia Therapy: The CHECK-UP Study: A Randomized Controlled Trial,” Arch Intern Med 167, no. 21 (November 26, 2007), http://archinte.ama-assn.org/cgi/content/abstract/167/21/2296 (accessed November 27, 2007).</ref> 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. | ||
Revision as of 12:25, 26 February 2008
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; however, more recently interactive software or websites can help interact with the patient.[2][3] 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[4].
Shared decision making combines evidence-based medicine with the preferences of patients.Many medical decisions are not strictly based on science. Patients have values that emphasize risks and benefits differently from their doctor. There is frequently more than one correct decision. Emerging importance of patient autonomy. Recognition of informed consent as an important component of decision making. Risk-benefit calculation renders not a single absolute recommendation but an assessment of outcome with more or less statistical certainty behind it.
Shared decision making emphasizes the importance of communication in the process of making a decision.
Shared decision making should be contrasted with informed consent, and simple consent.[5]
Legal rationale
Court cases such as the 1990 Cruzan v. Director, Missouri Department of Health Supreme Court case and the 1976 case of Karen Ann Quinlan have increased the importance of patient autonomy in medical ethics; shared decision making entails giving patients more influence in medical decisions.
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.[6] 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.
References
- ↑ Anonymous (2024), Patient participation (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Frosch, D. L., Bhatnagar, V., Tally, S., Hamori, C. J., & Kaplan, R. M. (2008). Internet patient decision support: a randomized controlled trial comparing alternative approaches for men considering prostate cancer screening, Arch Intern Med, 168(4), 363-369. doi: 10.1001/archinternmed.2007.111.
- ↑ Barry MJ (2002). "Health decision aids to facilitate shared decision making in office practice". Ann. Intern. Med. 136 (2): 127–35. PMID 11790064. [e]
- ↑ Buchanan A (1978). "Medical paternalism". Philos Public Aff 7 (4): 370-90. PMID 11664929.
- ↑ 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. [e]
- ↑ Steven A. Grover et al., “Patient Knowledge of Coronary Risk Profile Improves the Effectiveness of Dyslipidemia Therapy: The CHECK-UP Study: A Randomized Controlled Trial,” Arch Intern Med 167, no. 21 (November 26, 2007), http://archinte.ama-assn.org/cgi/content/abstract/167/21/2296 (accessed November 27, 2007).