An overview of patient involvement in healthcare decision-making: a situational analysis of the Malaysian context

Abstract

BackgroundInvolving patients in decision-making is an important part of patient-centred care. Research has found a discrepancy between patients’ desire to be involved and their actual involvement in healthcare decision-making. In Asia, there is a dearth of research in decision-making. Using Malaysia as an exemplar, this study aims to review the current research evidence, practices, policies, and laws with respect to patient engagement in shared decision-making (SDM) in Asia.MethodsIn this study, we conducted a comprehensive literature review to collect information on healthcare decision-making in Malaysia. We also consulted medical education researchers, key opinion leaders, governmental organisations, and patient support groups to assess the extent to which patient involvement was incorporated into the medical curriculum, healthcare policies, and legislation.ResultsThere are very few studies on patient involvement in decision-making in Malaysia. Existing studies showed that doctors were aware of informed consent, but few practised SDM. There was limited teaching of SDM in undergraduate and postgraduate curricula and a lack of accurate and accessible health information for patients. In addition, peer support groups and 'expert patient’ programmes were also lacking. Professional medical bodies endorsed patient involvement in decision-making, but there was no definitive implementation plan.ConclusionIn summary, there appears to be little training or research on SDM in Malaysia. More research needs to be done in this area, including baseline information on the preferred and actual decision-making roles. The authors have provided a set of recommendations on how SDM can be effectively implemented in Malaysia.

Training health professionals in shared decision making: Update of an international environmental scan

“…A survey in Japan showed that patients there do want to be more involved in healthcare decision-making [21] and new programs have been created in Japan and South Korea. Other Asian countries are challenged by scarce healthcare resources and an overburdened healthcare system [22]. Furthermore, we were still unable to identify any SDM training programs in Africa, India, Russia, South America or China, perhaps an indicator that the approach has not taken hold in these contexts.…”

Shared decision making: Concepts, evidence, and practice

“…Indeed skills training for residents as well as specialists is starting to bud, but mostly so in Western countries such as North-Western Europe, Canada, the US, and Australia [67]. Elsewhere, some groups are active in this field, but the efforts seem incidental so far [68].…”

Factors influencing implementation of a patient decision aid in a developing country: an exploratory study

“…This resistance to SDM would hinder the adoption of SDM and subsequently lead to non-use of the insulin PDA. There is a distinct contrast in SDM implementation between developed countries (such as the USA, UK, Germany, Netherlands, Australia, Italy and Spain) where SDM and the use of PDAs have already been implemented at policy and legislation levels [28–31] and developing countries in Asia see slower progress in adopting SDM and PDAs [15, 32]. In Switzerland, however, hierarchical structures and asymmetric physician-patient relationship were reported to be barriers for SDM implementation despite doctors recognizing its importance [31].…”

“…The Patient Decision Aids Research Group has created continuous education such as online tutorials, interactive workshops, performance feedback and structured protocols in providing decision support [18]. Efforts are also needed to empower patient in being more involved in their healthcare, and one way to do that is to conduct public health campaigns [15]. In developed countries such as Australia and the UK, the ‘AskShareKnow’ [35, 36] and the ‘Ask three questions’ [37, 38] campaigns are conducted to encourage patients to ask their HCPs the three questions (‘What are my options?’, ‘What are the benefits and harms?’ and ‘How likely are these going to happen?’) to increase patient involvement in healthcare.…”

“…It has a population of 28.3 million, comprising three main ethnic groups namely Malay (67.4%), Chinese (24.6%) and Indian (7.3%) [14]. The implementation of SDM in Malaysia is hampered by several factors including the multi-cultural and language diversity of the population and the lack of patient involvement in healthcare [15]. In Malaysia, although the national language is the Malay language, not all Chinese or Indian patients are fluent in this language.…”