Exploring patient involvement in healthcare decision making across different education and functional health literacy groups

Smith, Sian K; Dixon, Ann; Trevena, Lyndal; Nutbeam, Don; McCaffery, Kirsten

doi:10.1016/j.socscimed.2009.09.056

Cited by 300 publications

(237 citation statements)

References 33 publications

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“…27 The low desire of patients in deprived areas to be actively involved in decision making also agrees with other studies. [28][29][30] Our finding that consultations in deprived areas were less patient-centered agrees with a review of the literature that found that physicians are generally much more directive with patients of low educational status. 31 Perceived GP empathy (as gauged by the CARE measure) was also lower in the deprived group than the affluent, and empathy was a significant independent predictor of better outcomes at 1 month in both deprived and affluent groups.…”

Section: Relationship To Published Literaturesupporting

confidence: 86%

General Practitioners’ Empathy and Health Outcomes: A Prospective Observational Study of Consultations in Areas of High and Low Deprivation

et al. 2016

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PURPOSE We set out to compare patients' expectations, consultation characteristics, and outcomes in areas of high and low socioeconomic deprivation, and to examine whether the same factors predict better outcomes in both settings.METHODS Six hundred fifty-nine patients attending 47 general practitioners in high-and low-deprivation areas of Scotland participated. We assessed patients' expectations of involvement in decision making immediately before the consultation and patients' perceptions of their general practitioners' empathy immediately after. Consultations were video recorded and analyzed for verbal and nonverbal physician behaviors. Symptom severity and related well-being were measured at baseline and 1 month post-consultation. Consultation factors predicting better outcomes at 1 month were identified using backward selection methods. RESULTSPatients in deprived areas had less desire for shared decision-making (P <.001). They had more problems to discuss (P = .01) within the same consultation time. Patients in deprived areas perceived their general practitioners (GPs) as less empathic (P = .02), and the physicians displayed verbal and nonverbal behaviors that were less patient centered. Outcomes were worse at 1 month in deprived than in affluent groups (70% response rate; P <.001). Perceived physician empathy predicted better outcomes in both groups.CONCLUSIONS Patients' expectations, GPs' behaviors within the consultation, and health outcomes differ substantially between high-and low-deprivation areas. In both settings, patients' perceptions of the physicians' empathy predict health outcomes. These findings are discussed in the context of inequalities and the "inverse care law."

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Section: Relationship To Published Literaturesupporting

confidence: 86%

General Practitioners’ Empathy and Health Outcomes: A Prospective Observational Study of Consultations in Areas of High and Low Deprivation

et al. 2016

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“…15,29,30 This study provides new insight regarding the context in which many older adults manage their health, engage in health care decision-making, and experience health care demands. Emerging evidence that patients commonly elect to involve family or close friends in routine or difficult treatment decisions 20,[31][32][33] has prompted elaborations of shared decision-making models that explicitly include family. 20,21 These are the first national data to specifically elicit decision-making preferences of older adults that extend beyond their doctor, and we find that a substantial one-third of older adults prefer to share or leave health care decisions to family members and close friends.…”

Section: Discussionmentioning

confidence: 99%

A Look at Person-Centered and Family-Centered Care Among Older Adults: Results from a National Survey

Wolff

Boyd

2015

J GEN INTERN MED

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BACKGROUND:Person-centered and family-centered care represents the pinnacle of health care quality, but delivering it is challenging, as is assessing whether it has occurred. Prior studies portray older adults as passive in health decisions and burdened by care-but emphasize age-based differences or focus on vulnerable subgroups. OBJECTIVES: We aimed to examine domains of person-centered and family-centered care among older adults and whether the social context in which older adults manage their health relates to preferences for participating in health decisions and experiences with care. DESIGN AND PARTICIPANTS: This was an observational study of a nationally representative survey of adults aged 65+ years, conducted in concert with the 2012 National Health and Aging Trends Study (n=2040). MAIN MEASURES: Approach to managing health (selfmanage, co-manage, delegate); preferences for making health care decisions with: (1) doctors, (2) family/close friends; and experiences with care pertaining to treatment burden were measured. KEY RESULTS: Approximately two-thirds of older adults self-manage (69.4 %) and one-third comanage (19.6 %) or delegate (11.0 %) health care activities. The majority prefer an independent or shared role when making health decisions with doctors (84.7 %) and family/close friends (95.9 %). Nearly four in ten older adults (37.9 %) experience treatment burden-that managing health care activities are sometimes or often hard for either them or their family/close friends, that health care activities get delayed or don't get done, or that they are cumulatively too much to do. Relative to older adults who self-manage, those who delegate health care activities are more likely to prefer to share or leave health decisions to doctors (aOR=1.79 (95 % CI, 1.37-2.33) and family/close friends (aOR=3.12 (95 % CI, 2.23-4.36), and are more likely to experience treatment burden (aOR= 2.37 (95 % CI, 1.61-3.47). CONCLUSIONS: Attaining person-centered and familycentered care will require strategies that respect diverse decision-making preferences, minimize treatment burden, and support the broader social context in which older adults manage their health.

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“…The [28,29] and provide additional evidence to support the development of effective and ecological strategies to foster HL. These results also contribute to raise awareness among healthcare professionals about the role of HL skills in a family-centered approach to communication and participation.…”

Section: Strengths and Limitationsmentioning

confidence: 97%

Health Literacy Skills in Relatives? Speech: A Canadian Case-Study

Clure

Rochette²

2013

J Community Med Health Educ

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Exploring patient involvement in healthcare decision making across different education and functional health literacy groups

Cited by 300 publications

References 33 publications

General Practitioners’ Empathy and Health Outcomes: A Prospective Observational Study of Consultations in Areas of High and Low Deprivation

General Practitioners’ Empathy and Health Outcomes: A Prospective Observational Study of Consultations in Areas of High and Low Deprivation

A Look at Person-Centered and Family-Centered Care Among Older Adults: Results from a National Survey

Health Literacy Skills in Relatives? Speech: A Canadian Case-Study

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