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PATIENTS WANT INVOLVEMENT IN TREATMENT DECISIONS
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Key Point
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| Many patients with asthma desire more involvement in treatment decisions. |
MANCHESTER, UK—Among patients with asthma, preferred and perceived levels of participation in treatment decisions do not seem to match. This mismatch, according to a recent study, highlights the need for professional and patient education regarding partnership working, skillful communication, and innovative approaches to service delivery.1
Ann Caress, PhD, and colleagues surveyed 230 adults with asthma to identify patients’ preferred and perceived levels of involvement in treatment decisions, perceived facilitators of and barriers to involvement, and the relationship between decisional role preferences and demographic variables.
Degner et al’s Control Preferences Scale was used to determine each patient’s preferred level of involvement in treatment decisions. Those who favored an active role preferred to make the final decision about which treatment to receive, either with or without the doctor’s opinion. Those who favored a collaborative role preferred to share the responsibility for choosing the best treatment. Those who favored a passive role preferred that the doctor make the final decision about treatment.
According to the researchers, 23.9% of patients preferred an active role, 35.7% preferred a collaborative role, and 40.4% preferred a passive role in treatment decisions. By contrast, only 8.2% of patients perceived their role as active, 19.6% perceived their role as collaborative, and 72.2% perceived their role as passive.
Patients identified the following as barriers to their participation in treatment decision making:
- Patients’ lack of knowledge regarding asthma and its treatment.
- Patients’ personal characteristics (eg, unassertiveness, age, inability to understand).
- Patient being in a life-threatening situation.
- Health professionals’ poor interpersonal skills.
- Health professionals’ unwillingness to listen or to accept patients’ expertise.
- Lack of time during consultations.
- Lack of contact with health professionals (eg, no regular review).
Dr. Caress and her colleagues also found that demographic variables and asthma severity were not strongly associated with role preferences.
The researchers commented that “while the focus of this study was asthma, the findings address aspects of provider-patient consultations which may have relevance in other long-term health problems.” They added that future research focused on improving the understanding of health care professionals’ perspectives on shared treatment decision making—particularly, perceived barriers to collaboration with their patients—would be helpful. “A comparison of providers’ and patients’ perspectives on the same treatment decision would also be worthwhile, especially as work elsewhere suggests that health professionals are poor at identifying patients’ needs and preferences.” The investigators highlighted the potential of personalized asthma action plans as a means of increasing patients’ involvement in their own care.
—Karen L. Spittler
Reference
1. Caress AL, Beaver K, Luker K, et al. Involvement in treatment decisions: what do adults with asthma want and what do they get? Results of a cross sectional survey. Thorax. 2005;60:199-205.
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