Patient participation
Encyclopedia
Patient participation, also called shared decision making
, is "patient involvement in the decision-making process in matters pertaining to health".
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. 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.
The quality of online decision aids is uncertain.
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. IPDAS have published a set of standards representing the efforts of more than 100 participants from 14 countries around the world.
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. 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.
Shared decision making
Shared decision-making is an approach where clinicians and patients communicate together using the best available evidence when faced with the task of making decisions, where patients are supported to deliberate about the possible attributes and consequences of options, to arrive at informed...
, is "patient involvement in the decision-making process in matters pertaining to health".
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. Variations of each method may be preferred by different patients.
Shared decision making combines evidence-based medicine
Evidence-based medicine
Evidence-based medicine or evidence-based practice aims to apply the best available evidence gained from the scientific method to clinical decision making. It seeks to assess the strength of evidence of the risks and benefits of treatments and diagnostic tests...
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
Informed consent
Informed consent is a phrase often used in law to indicate that the consent a person gives meets certain minimum standards. As a literal matter, in the absence of fraud, it is redundant. An informed consent can be said to have been given based upon a clear appreciation and understanding of the...
, and simple consent.
Using computers to interact with patients
Recently, interactive software or Internet websites can help interact with the patient. In some studies, Internet-based interventions improve upon usual care whereas in other studies interpersonal interventions are better.The quality of online decision aids is uncertain.
The International Patient Decision Aid Standards (IPDAS) Collaboration is a group of researchers led by professors Annette O'Connor in Canada and Glyn Elwyn
Glyn Elwyn
Glyn Elwyn is Professor of Primary Care at Cardiff University where he leads the [Decision Laboratory], developing and evaluating decision support interventions such as Prosdex , Amniodex and Bresdex , tools that help clinicians achieve shared decision making.He first completed an arts degree in ...
in the UK working towards developing an internationally approved set of criteria to determine the quality of patient decision aids. IPDAS have published a set of standards representing the efforts of more than 100 participants from 14 countries around the world.
Effectiveness of patient participation
A randomized controlled trialRandomized controlled trial
A randomized controlled trial is a type of scientific experiment - a form of clinical trial - most commonly used in testing the safety and efficacy or effectiveness of healthcare services or health technologies A randomized controlled trial (RCT) is a type of scientific experiment - a form of...
of patients at very high risk of coronary events found that use of two clinical prediction rule
Clinical prediction rule
A clinical prediction rule is type of medical research study in which researchers try to identify the best combination of medical sign, symptoms, and other findings in predicting the probability of a specific disease or outcome....
s (http://www.chiprehab.com/CVD/) for predicting coronary events along with tailored feedback, may improve cholesterol values. 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.