Patient involvement and shared decision-making: an analysis of components, models and practical knowledge

Abstract

Patient involvement and shared decision-making are prominent ideas in healthcare policy discourses and the focus of extensive analysis in health services research and social sciences scholarship. In this paper, we reflect on the different kinds of knowledge that might help professionals to more fully translate these ideas and the broader ideals of collaborative healthcare, into everyday clinical practice. To do this, we offer a brief account of 8 components of involvement and indicate the ways in which the plurality of these components highlights the complexity of and dilemmas inherent in, patient involvement practices. We also present various models of involvement as 'summary pictures' which foreground specific constellations of these components. We argue that if we are to engage with involvement seriously, we require conceptions of knowledge that recognize and reflect the inherent tensions within and across models of involvement. That is, we need to pay attention not only to technical knowledge -the question of 'what works' -but also to 'practical wisdom' -the question of what counts as working from case to case.

Clinicians' perspective on an app for patient self‐monitoring in eating disorder treatment

“…RR may be seen as a tool for increased patient involvement, as the app aims at engaging patients in a way that is expected to be more in line with patient preferences than paper‐and‐pen meal diaries (Juarascio et al, ; Research2guidance, ). Thus, in line with Cribb and Donetto (), our results may indicate that the setting at the ED treatment facility studied does not yet have the capability to handle the impact on treatment and work conditions that accompanies the adoption of RR. As this may be the case at other treatment facilities too, we encourage managements and clinicians here to carefully consider the potential advantages and disadvantages of adopting RR before adopting it, and thoroughly discuss the development and application of specific and explicit practical guidelines for clinician and patient app usage fitting the existing setting.…”

A qualitative study analysing the journey towards an embedded approach to service user involvement

“…From the perspective of both young mothers and students it offered the opportunity to provide honest accounts from an emic perspective that allowed users to confront professional stereotypes, in a safe setting. Young mothers were empowered to challenge professional dominance, arguing that professional assessments sometimes fail to acknowledge how broader social problems and structural disadvantage are experienced by those living with the everyday reality , making health visiting services less accessible (Hogg et al 2012;Cribb and Donetto 2013;Morrow et al 2012). Nevertheless, this study demonstrates the importance of allowing time and resources to support involvement if it is to be meaningful to users.…”

“…Developing trust as the basis for meaningful service user involvement in research as well as service delivery that is more than tokenistic is in itself important and lay at the heart of this approach (Cleminson and Moesby 2013, Morrow et al 2012, Cribb and Donetto 2013, Wells et al 2008, Tew et al 2004. Challenging traditional power relationships, between professionals and service users can play an important role in shaping student learning in this area as can role modelling user rather than professional led approaches to both research and service development (Cleminson and Moesby 2013, Morrow et al 2012, Cribb and Donetto 2013, Wells et al 2008.…”

“…Consequently, Morrow et al (2012) argue that this is significant for marginalised groups often referred to as "hard to reach", who report finding access to services challenging and sometimes discriminatory (Cribb and Donetto 2013). This influences not only their use of services in the future, but also their ability to become involved and influence service development.…”

Implementation of patient involvement methods in the clinical setting: A qualitative study exploring the health professional perspective

“…On the other hand, the high specialization may turn the focus away from the individual patient's personal needs and preferences in the provided care. Thus, patient involvement requires an integration of highly specialized functions and interpersonal skills in the health care staff …”