The importance of patient-centred decision-making

In the UK recently there has been a series of high profile stories of abuse, neglect and lack of care in the very places we most expect to be cared for – in our hospitals, doctors’ surgeries and nursing homes.

New training courses and conferences have sprung out of nowhere to explore the causes and possible treatments of this state of affairs; processes and procedures to encourage compassionate care are now much debated. In April, the General Medical Council departed from its usual remit and published a new guide, “What to expect from your doctor: a guide for patients”. The focus has been increasingly on a patient-centred approach to improve both the experience and outcomes of health care.

In the drive for better outcomes much work continues on improving the technical processes of healthcare based on the most up to date evidence, the ‘science’ of medicine – and rightly so. But the essential nature of the human interaction between the patient and the caregiver, the ‘art’ of medicine, can be so easily overlooked, pushed out by laboratory results, imposed targets and the time pressures of modern healthcare systems.

Previous editions of the PRIME International Email have highlighted both the need and the evidence for continuing professional education, role modelling and the interpersonal aspects of care that are crucial to improve our patients’ benefit from our clinical practice. We expect the supporting evidence-base to increase further over coming years and look forward to continuing to highlight such research to members of the PRIME Network.

A recent study of patient-centred decision-making published in the Annals of Internal Medicine (1) highlights the impact of such care on clinical outcomes. Based on encounters between 139 resident physicians and 774 patients, Weiner and colleagues explored whether identifying and responding to patient-specific circumstances led to an improved outcome.  A total of 548 potentially important patient-related factors were noted on first contact; 208 were confirmed when further information was obtained, although physician attention to these factors varied. Patient outcome data were available for 157 ‘contextual’ factors. Of these, 96 were addressed by patient-centred decision-making which resulted in improved health outcomes in 68 (71%). This compared with an improvement in only 28 (46%) where patient-specific factors were ignored.

In the editorial of the same edition of the Annals of Internal Medicine (2) Aboumatar and Cooper highlighted the need for both patient-centredness and cultural competence. “Patient-centred care is care that is respectful and responsive to individual patient preferences, needs and values and ensures that patient values guide all clinical decisions. Cultural competence in healthcare is the ability of healthcare professionals to provide care to patients with diverse values, beliefs and behaviours and includes tailoring delivery to meets patients’ social, cultural and linguistic needs.” They continue to explain that, “at the core of patient-centredness and cultural competence is the ability of healthcare professionals to see patients as individuals, build effective rapport, use the biopsychosocial model, explore patient beliefs, values and attitudes toward illness and find common ground regarding treatment plans.”

In addition, other contemporary research shows clear links between patient-centred care and several beneficial outcomes: patient satisfaction, perceptions of care, shared decision-making, health behaviours and adherence to treatment. A recent article in The Lancet (3) stated that, “The proliferation of reports on the failings of the doctor-patient interaction, and the numerous proposed solutions – more time, better health systems, more training, more compassion, more staff – point to the complex nature of this relationship. However, the continued dissatisfaction with the current state of affairs does at least remind us that although the background scenery has changed, the enigmatic ideal portrayed in Fildes’ picture is as real today as it was in 1891.”

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A clear focus on the patient reaps tangible and measureable benefits.

Jo Clark PRIME Operations Manager

References

1.  Ann Intern Med. 2013; 158: 573-579

2.  Ann Intern Med. 2013; 158: 628-629

3.  The Lancet 2013; 381: 1432

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One thought on “The importance of patient-centred decision-making

  1. Great stuff JO. This is key for our GPST doctors and would like to explore how to introduce this values lead training to them.

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