Incorporating patient preferences into orthopaedic practice: Should the orthopaedic encounter change?

被引:19
作者
Bryant, D
Bednarski, E
Gafni, A
机构
[1] Univ Western Ontario, Elborn Coll, Fac Hlth Sci, London, ON, Canada
[2] McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON L8S 4L8, Canada
[3] McMaster Univ, Fac Hlth Sci, Bachelor Hlth Sci Program, Hamilton, ON L8S 4L8, Canada
来源
INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED | 2006年 / 37卷 / 04期
关键词
patient preferences; patient values; patient-physician relationship; treatment decision-making; information exchange; decision-aids;
D O I
10.1016/j.injury.2006.01.030
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
The issues concerning treatment decision-making are that often options for treatment lead to uncertain outcomes (benefits and risks) at the individual patient level and that both patients and physicians might value these outcomes differently. There are three main approaches commonly used to describe treatment decision-making including paternalistic, shared and informed decision-making. The challenge and responsibility of physicians is to effectively communicate to patients that they should feel welcome to participate in decision-making through whichever approach seems suitable to them. Changes in laws governing the ethics of medical practice mandate a more comprehensive decision-making tactic requiring a two-way flow of information between patient and physician. The key to information exchange ties in evoking patient preferences by informing the patient of the benefits and risks associated with each treatment option. Decision aids have been developed in a variety of forms to facilitate this transfer of information about available treatment alternatives in as unbiased fashion as possible. We believe that treatment options presented should include not only those available by the particular physicians at that institution but also those available at outside institutions and within other healthcare systems. We discuss barriers for physicians who wish to encourage patient participation such as the power differential that exists between patients and physicians, factors related to health policy, and those unique to surgery. We believe that investigation is necessary to understand how the differences between types of medical practices, or even within a medical field, wilt influence the importance that patients attach to having their values and preferences considered during treatment decision-making and to evaluate how this importance changes as the severity of adverse events associated with treatment outcomes changes. We feet that it is important for physicians and surgeons to begin to think about these issues and how they might investigate potential resolutions for incorporating patient values and sharing their own preferences for treatment options with their patients during the orthopaedic encounter. (C) 2006 Elsevier Ltd. All rights reserved.
引用
收藏
页码:328 / 334
页数:7
相关论文
共 44 条
[1]   Patients' unvoiced agendas in general practice consultations: qualitative study [J].
Barry, CA ;
Bradley, CP ;
Britten, N ;
Stevenson, FA ;
Barber, N .
BRITISH MEDICAL JOURNAL, 2000, 320 (7244) :1246-1250
[2]   OVERCONFIDENCE AMONG PHYSICIANS AND NURSES - THE MICRO-CERTAINTY, MACRO-UNCERTAINTY PHENOMENON [J].
BAUMANN, AO ;
DEBER, RB ;
THOMPSON, GG .
SOCIAL SCIENCE & MEDICINE, 1991, 32 (02) :167-174
[3]   Misunderstandings in prescribing decisions in general practice: qualitative study [J].
Britten, N ;
Stevenson, FA ;
Barry, CA ;
Barber, N ;
Bradley, CP .
BMJ-BRITISH MEDICAL JOURNAL, 2000, 320 (7233) :484-488
[4]   THE PATIENTS ROLE IN CLINICAL DECISION-MAKING [J].
BRODY, DS .
ANNALS OF INTERNAL MEDICINE, 1980, 93 (05) :718-722
[5]   INFORMATION AND PARTICIPATION PREFERENCES AMONG CANCER-PATIENTS [J].
CASSILETH, BR ;
ZUPKIS, RV ;
SUTTONSMITH, K ;
MARCH, V .
ANNALS OF INTERNAL MEDICINE, 1980, 92 (06) :832-836
[6]   Shared decision-making in the medical encounter: What does it mean? (Or it takes at least two to tango) [J].
Charles, C ;
Gafni, A ;
Whelan, T .
SOCIAL SCIENCE & MEDICINE, 1997, 44 (05) :681-692
[7]   Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model [J].
Charles, C ;
Gafni, A ;
Whelan, T .
SOCIAL SCIENCE & MEDICINE, 1999, 49 (05) :651-661
[8]   Shared treatment decision making: What does it mean to physicians? [J].
Charles, CA ;
Whelan, T ;
Gafni, A ;
Willan, A ;
Farrell, S .
JOURNAL OF CLINICAL ONCOLOGY, 2003, 21 (05) :932-936
[9]   VARIATIONS IN THE USE OF MEDICAL AND SURGICAL SERVICES BY THE MEDICARE POPULATION [J].
CHASSIN, MR ;
BROOK, RH ;
PARK, RE ;
KEESEY, J ;
FINK, A ;
KOSECOFF, J ;
KAHN, K ;
MERRICK, N ;
SOLOMON, DH .
NEW ENGLAND JOURNAL OF MEDICINE, 1986, 314 (05) :285-290
[10]  
DEBER RB, 1994, CAN MED ASSOC J, V151, P171