Patient participation
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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. 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[2].
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.[3]
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.
Using computers to interact with patients
Recently, interactive software or Internet websites can help interact with the patient.[4][5][6] In some studies, Internet-based interventions improve upon usual care[7] whereas in other studies interpersonal interventions are better.[8]
The quality of online decision aids is uncertain.[9]
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.[10] 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.[11]
References
- ^ MeSH participation Patient participation
- ^ 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.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ 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.
- ^ Kypri, Kypros (2008-03-10). "Randomized Controlled Trial of Web-Based Alcohol Screening and Brief Intervention in Primary Care". Arch Intern Med. 168 (5): 530–536. doi:10.1001/archinternmed.2007.109. Retrieved 2008-03-11.
{{cite journal}}: Unknown parameter|coauthors=ignored (|author=suggested) (help) - ^ Green, Beverly B. (2008-06-25). "Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial". JAMA. 299 (24): 2857–2867. doi:10.1001/jama.299.24.2857. Retrieved 2008-06-25.
{{cite journal}}: Unknown parameter|coauthors=ignored (|author=suggested) (help) - ^ Svetkey LP, Stevens VJ, Brantley PJ; et al. (2008). "Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial". JAMA. 299 (10): 1139–48. doi:10.1001/jama.299.10.1139. PMID 18334689.
{{cite journal}}: Explicit use of et al. in:|author=(help)CS1 maint: multiple names: authors list (link) - ^ Levy AG, Sonnad SS, Kurichi JE, Sherman M, Armstrong K (2008). "Making sense of cancer risk calculators on the web". J Gen Intern Med. 23 (3): 229–35. doi:10.1007/s11606-007-0484-x. PMID 18188653.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ 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).
- ^ Krones T, Keller H, Sönnichsen A; et al. (2008). "Absolute cardiovascular disease risk and shared decision making in primary care: a randomized controlled trial". Ann Fam Med. 6 (3): 218–27. doi:10.1370/afm.854. PMID 18474884.
{{cite journal}}: Explicit use of et al. in:|author=(help)CS1 maint: multiple names: authors list (link)
See also
This article incorporates material from the Citizendium article "Patient participation", which is licensed under the Creative Commons Attribution-ShareAlike 3.0 Unported License but not under the GFDL.
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