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What
matters to Patients?
Here's what we think — click here.
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DelfiniApproach to Patient Decision-making
Studies show that physicians tend to describe decisions to patients,
but tend to exclude describing benefits, harms, risks, costs,
uncertainties and alternatives. Patient-centered care is about
choice. Physicians need to be prepared to discuss all these areas
with patients.
Studies
also show that patients have individual preferences for decision
styles depending upon their unique circumstances. These styles
are autonomous, physician-directed and shared. Autonomous decision-making
is performed solely by the patient. Physician-directed means
the physician chooses. Shared decision-making is jointly performed
by physicians and patients. Patient-centered care involves the
patient in deciding which decision style to use, based on that
patient's own needs, values and preferences.
Physicians may
wish to favor a more prescriptive style where the evidence is
strong. Shared-decision making is often most optimal where there
are uncertainties and/or equally reasonable alternatives.
Patient choice
is at the heart of patient-centered care: Patient
Decision-making Model
How you
communicate the differences in treatment choices in patients
hugely matters. Studies show an acceptance rate of 88% to 31%!
Click here to learn more about estimates
of effect.
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Recommended
Reading
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Physician-Patient
Communications (see also Delfini "Patient
Encounter Map" for Information & Engagement)
Beck RS, Daughtridge
R, Sloane PD.
Physician-Patient Communication in the Primary Care
Office: A Systematic Review.
JABFP 2002. 15:25-38. The Journal of the American Board of Family
Practice. PMID: 11841136. Abstract.
Delfini commentary here.
Hall JA; Roter
DL; Katz NR.
Meta-analysis of correlates of provider behavior in
medical encounters.
Medical Care;1988, 26:657-675. PMID: 3292851. Abstract.
Stewart MA.
Effective Physician-Patient Communication and Health
Outcomes: A Review
CMAJ 1995.152:1423-1433. PMID: 7728691. Abstract. Delfini commentary here.
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Decision-making
Epstein RM, Alper
BS, Quill TE.
Communicating evidence for participatory decision making.
JAMA. 2004 May 19;291(19):2359-66. Review. PMID: 15150208. Abstract.
Say R, Thomson
R.
The importance of patient preferences in treatment decisions
— challenges for doctors.
BMJ. 2003 Sep 6;327(7414):542-5 Full
text. Delfini commentary here.
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Conveying
Risk (see also Delfini Rx
Messaging Scripts™ here )
Gigerenzer G, Edwards
A.
Simple tools for understanding risks: from innumeracy
to insight.
BMJ. 2003 Sep 27;327(7417):741-4.
PMID: 14512488. Full
text.
Paling J.
Strategies to help patients understand risks.
BMJ. 2003 Sep 27;327(7417):745-8. PMID: 14512489. Full
text.
O'Connor AM, Legare F, Stacey D.
Risk communication in practice: the contribution of
decision aids.
BMJ. 2003 Sep 27;327(7417):736-40. PMID: 14512487. Full
text.
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Adherence
McDonald HP, Garg
AX, Haynes RB.
Interventions to enhance patient adherence to medication
prescriptions: scientific review.
Health Research Methodology Program, McMaster University School
of Graduate Studies, Hamilton, Ontario, Canada. JAMA 2002 Dec
11;288(22):2868-79 PMID: 15139471. Abstract.
Delfini commentary here.
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