Helping patients participate in medical decision-making

20170308100000, Bee Kee Ng
The active engagement of patients in the medical decision-making can lead to better outcomes.
Patients have been urged to be more involved in monitoring their acute conditions and actively decide on their treatments. Nevertheless, many people are still refrained from making their own choices while many doctors are reluctant to change their old ways of working.

“Shared decision-making allows patients to engage in a deliberative, communicative process with their clinicians, and be active participants in their care,” said Angie Fagerlin, president of the Society for Medical Decision Making.

Currently, researchers and healthcare providers are attempting to change the ‘doctor-knows-best’ impression and allow patients to take control of their health. There are three approaches to make patients more confident about making decisions.

Providing more options and information

Scotland’s chief medical officer, Catherine Calderwood, stressed that doctors should provide more “realistic” information on the risks and benefits of medication and procedures.

To do this, doctors can use decision aids that are now extended to online videos and interactive programmes, educating patients on the possible risks and benefits of all options.

A review in 2014 found that decision aids help patients to be more informed of their condition and encourage them to participate more in decision making, while a 2016 study reported that the aids improved the quality of patient care and changed discussions with patients.

Leigh Simmons, medical director of Health Decisions Sciences Centre, said, “We want to be operating on people who want surgery, not those who don’t know enough or aren’t ready.”

Her patient, Harriet Broyles, 77, said an online video version of the decision aid helped her decide to forgo a second surgery and opt for physical therapy and cortisone shots.

“The video answered a lot of questions I didn’t pay attention to the first time,” said Broyles.

Modern medicine tends to over medicalise, according to Calderwood, and hence, it is important to take patients’ expectations into account.

Presenting simpler information

To help patients understand better, doctors are also improving the way they present complex medical information.

“Patients are often overwhelmed by massive amounts of data they now have access to,” said Brian J. Zikmund-Fisher, an associate professor at the University of Michigan School of Public Health.

“The easier we make it for them to understand, the more likely it is they will use it and the less time the doctor has to spend explaining it.”

At the same time, Zikmund-Fisher and colleagues at the University of Michigan developed a web-based application that assist researchers and healthcare providers to create graphics that display information using icons in arrays, making it more accessible.

The study by Zikmund-Fisher and colleagues found that breaking decision down can help patients to better understand what is involved at each stage. Photo credit: The Wall Street Journal
The study by Zikmund-Fisher and colleagues found that breaking decision down can help patients to better understand what is involved at each stage. Photo credit: The Wall Street Journal


A survey also found that women who considered therapy options one at a time had significantly better comprehension of relevant risk information than those who had to consider all options at once.

Offering electronic medical records

As consultation time is limited, more doctors are using electronic medical records to provide medical advice such as secure email messaging and direct access to test results. One such model is OpenNotes, developed at Beth Israel Deaconess Medical Center in Boston, to allow doctors and other healthcare professionals engage with their patients by sharing their written consultation notes.

Bella Wong, a lung disease patient who once viewed doctor’s words as “gospel”, said that online access to her records and doctor’s notes helped her become more engaged with her medical situation.

“I want to know everything that is available to me and understand all my options — you are not just telling me what to do, we are making a decision together,” she said.

In the context of Malaysia, it may be perceived that patients would not want to be involved in the decision-making process. However, studies have found that patients prefer a shared decision, with family playing an important role. On the other hand, healthcare professionals in Malaysia have differing views on their decisional roles and their view on patients’ preferred roles in treatment options.

The gap between patients’ expectations and what is perceived by healthcare professionals need to be bridged. Thus, it is important for healthcare professionals to adopt a culturally sensitive model of shared decision-making in an Asian clinical context. MIMS

Read more:
5 ways to maximise patient engagement
Better patient communication by being less “like a doctor”
Engaging patients on the digital platform via “vlogging”

Sources:
https://www.wsj.com/articles/how-to-get-patients-to-take-more-control-of-their-medical-decisions-1488164941
http://www.bbc.com/news/uk-scotland-39096315
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0142812
http://bmjopen.bmj.com/content/6/1/e010063.full