A new study published in the May issue of Health Affairs finds that some patients are concerned about being labeled “difficult” if they ask too many questions or disagree with a recommendation from their physician. “We found that patients want to participate in making decisions with their physicians, but feel vulnerable and worried that they might be perceived as too assertive, resulting in lower quality care in the future,” says Dr. Dominick Frosch, lead author of the study.
Occasionally, all citizens have to make important health decisions that affect health outcomes. Strategies to support patient education and engagement should therefore be a fundamental plank of health policy. Also, patients can play an important role in understanding the causes of illness, protecting their health and taking appropriate action, choosing appropriate treatments for acute episodes of ill health, and managing chronic illness. These roles must be recognized and supported.
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?
Clinicians in the U.S. may miss two of every 100 patients with acute myocardial infarction or unstable angina (i.e., acute coronary syndromes, or ACS) presenting to the emergency department (ED) even after considering the history, physical examination, initial electrocardiogram and cardiac biomarkers (troponin levels).
It is hypothesized that the introduction of decision aids will improve the quality of treatment decisions regarding fracture by leading to bisphosphonate start eliciting patient involvment in the decision making process. It is hypothesized that patients will become more involved in the decision making process and decisions will be more consistent with patients' lifestyles--decision aids (DAs) will lead to bisphosphonate start and adherence in patients at high risk of fracture and to patients stopping medication or not starting in patients at low risk.