Clinical Decision Processes and Patient Engagement in Self-Management

Self-management is an essential component of disease management that involves collaboration between patients and healthcare providers to ensure patient engagement in behaviors that help control or reduce the impact of their disease. The self-management model assists patients in gaining skills to manage their disease and, more importantly, in gaining the confidence to apply these skills on a day-to-day basis. The key processes in self-management are goal selection, information collection and interpretation, decision making, action, and self-efficacy. Patients must be active in goal selection, and treatment goals must be agreed between the patient and the healthcare provider. Patients have to be able to collect information through self-monitoring, self-observation, and recording of data. Interpretation of this information is useful to both patients and healthcare providers as it enables refinement of self-management practices. Decision making is essential for effective self-management - patients need to be able to select what actions to take. Action refers to the performance of self-management skills - patients must not only learn the skill but also be competent and successful in it. This will enhance self-efficacy, which is essential if we want patients to be successful in performing and maintaining a specific behavior. For self-management to be effective, skills that are mastered also have to be maintained over time. Feedback from healthcare professionals coupled with the patient's own experiences in controlling chronic obstructive pulmonary disease (COPD) improves the patient's subsequent performance of self-management activities and their self-efficacy with regard to those activities. Compared with traditional care plans, self-management promotes more active patient participation and focuses more on the acquisition and practice of new skills. It appears that patients experience better control of COPD when they learn, execute, and continue to perform self-management processes throughout the course of their disease.