Patients' choices and perceptions after an invitation to participate in treatment decisions

England, Stephanie Legg; Evans, Jeremy

doi:10.1016/0277-9536(92)90314-g

Cited by 70 publications

(33 citation statements)

References 44 publications

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“…Our research helps account for previous findings of a discrepancy between doctors" and patients" perceptions of the decision-making process [33][34]. It may be that, having used the "machinery" of the menu-based approach, doctors perceive themselves to have offered the patient "choice," while the patient may (sometimes quite correctly) perceive the way in which the doctor produces the options as constraining.…”

Section: Implications For Practicesupporting

confidence: 62%

Offering patients choices: A pilot study of interactions in the seizure clinic

Toerien

Shaw

Duncan

et al. 2011

Epilepsy & Behavior

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Using Conversation Analysis (CA), we studied conversations between one UK-based epilepsy specialist and thirteen seizure patients in whom there was uncertainty about the diagnosis, and for whom different treatment and investigational options were being considered. In line with recent communication guidance, the specialist offered some form of choice to all patients: in eight cases, a course of action was proposed, to be accepted or rejected, and in the remaining five a "menu" of options was offered. Even when presenting a menu, the specialist sometimes conveyed his own preferences in how he described the options, and in some cases the menu was used for reasons other than offering choice (e.g. to address patient resistance). Close linguistic and interactional analysis of clinical encounters can show why doctors may feel they are offering choices when patients report that the decision was clinician-dominated.

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Section: Implications For Practicesupporting

confidence: 62%

Offering patients choices: A pilot study of interactions in the seizure clinic

Toerien

Shaw

Duncan

et al. 2011

Epilepsy & Behavior

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“…For example, research 25 suggests that patients who think they have chosen their treatment have better health outcomes than those who think they have not -despite receiving the same treatment. Patients have also been found to be more likely to follow a treatment plan they have chosen, and increased patient satisfaction with the consultation, confidence in the doctor's recommendations and greater psychological well-being are all associated with more involvement in decision-making.…”

Section: Models Versus Practices: Our Methodological Starting Pointmentioning

confidence: 99%

“…withdrawing all medication; see lines 12 and 13) is 'another thing' they could add to the list (see line 18), he goes on to reiterate his version (i.e. continuing with the current dose of azathioprine, lines [22][23][24][25][26]. He thereby makes it apparent that he is not in favour of the patient's proposal.…”

Section: Option-listing: An Effective Practice?mentioning

confidence: 99%

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Delivering patient choice in clinical practice: a conversation analytic study of communication practices used in neurology clinics to involve patients in decision-making

Reuber

Toerien

Shaw

et al. 2015

Health Services and Delivery Research

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BackgroundThe NHS is committed to offering patients more choice. Yet even within the NHS, the meaning of patient choice ranges from legal ‘rights to choose’ to the ambition of establishing clinical practice as a ‘partnership’ between doctor and patient. In the absence of detailed guidance, we focused on preciselyhowto engage patients in decision-making.ObjectivesTo contribute to the evidence-base about whether or not, and how, patient choice is implemented to identify the most effective communication practices for facilitating patient choice.DesignWe used conversation analysis to examine practices whereby neurologists offer choice. The main data set consists of audio- and video-recorded consultations. Patients completed pre- and post-consultation questionnaires and neurologists completed the latter.Setting and participantsThe study was conducted in neurology outpatient clinics in Glasgow and Sheffield. Fourteen neurologists, 223 patients and 120 accompanying others took part.ResultsPatients and clinicians agreed that choice had featured in 53.6% of consultations and that choice was absent in 14.3%. After 32.1% of consultations,eitherpatientorneurologist thought choice was offered. The presence or absence of choice was not satisfactorily explained by quantitatively explored clinical or demographic variables. For our qualitative analysis, the corpus was divided into four subsets: (1) patient and clinician agree that choice was present; (2) patient and clinician agree that choice was absent; (3) patient ‘yes’, clinician ‘no’; and (4) patient ‘no’, clinician ‘yes’. Comparison of all subsets showed that ‘option-listing’ was the only practice for offering choice that was presentonly(with one exception, which, as we show, proves the rule) in those consultations for which participantsagreed there was a choice. We show how option-listing can be used to engage patients in decision-making, but also how very small changes in the machinery of option-listing [for instance the replacement or displacement of the final component of this practice, the patient view elicitor (PVE)] can significantly alter the slot for patient participation. In fact, a slightly modified form of option-listing can be used to curtail choice. Finally, we describe two forms of PVE that can be used to hand a single-option decision to the patient, but which, we show, can raise difficulties for patient choice.ConclusionsChoice features in the majority of recorded consultations. If doctors want to ensure a patient knows she or he has a choice, option-listing is likely to be best understood by patients as an invitation to choose. However, an important lesson from this study is that simply asking doctors to adopt a practice (like option-listing) will not automatically lead to a patient-centred approach. Our study shows that preciselyhowa practice is implemented is crucial.Future researchFuture research should investigate (1) links between the practices identified here and relevant outcome measures (like adherence); (2) whether being given a choice is better or worse for patients than receiving a doctor’s recommendation, taking account of clinical and demographic factors; and (3) how our approach could be fruitfully applied in other settings.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…4).16% of patient found that arrangement for prevention of insect to be very good, 57% found it good but 27% of patient healthcare treatment and option 5 . There is a growing evidence of the links between consumer feedback and participation in decision making in individual care leads to improvement in health outcomes 6,7 and stronger therapeutic alliances. Effective consumer feedback strategies make organizations more aware of significant areas of dissatisfaction with care and services 8 , give staff new insight into how people perceive aspects of their care and increase consumer confidence 9 .…”

Section: Discussionmentioning

confidence: 99%