Dilemmas in patient centeredness and shared decision making: A case for vulnerability

doi:10.1016/j.pec.2006.06.012

Patient Education and Counseling

Volume 62, Issue 3, September 2006, Pages 291-298

https://doi.org/10.1016/j.pec.2006.06.012 Get rights and content

Introduction

Better than larger values – That show however true – This timid life of evidence keeps pleading – ‘I do not know’; Emily Dickinson (Fascicle 35–11).

This paper deals with patient centeredness and shared decision making as well as the dilemmas involved for physicians when communicating along the lines suggested in these models. Both patient centeredness and shared decision making have been advocated as the starting point of good communication in recent medical education programs. Also, these models would lead to improved patient reported outcomes, such as satisfaction, treatment adherence and health. Given the empirical evidence accumulated to date, one may have to conclude that such advantages are more difficult to reach and that a more nuanced standpoint has to be taken. This will be addressed, firstly, by looking at the history of the use of the concepts. Secondly, data are addressed that seem to indicate that a differentiated picture may be needed. Thirdly, theoretical approaches to explain non-supportive findings will be forwarded. Finally, conclusions will be drawn and some suggestions for a future approach will be given.

Section snippets

Ideology and conceptual issues

Over the last decades, a plea for patient centeredness was universally heard in medicine. This attention evolved from and was contrasted with illness-centered or doctor centered medicine. In their review on patient centeredness, Mead and Bower [1] asserted that ‘patient centeredness is a concept that has evolved from dissatisfaction with the conventional biomedical model of medicine to embody a complex set of professional, sociological and political ideas about the doctor–patient relationship’.

Non-supportive findings

Given the common elements formulated above, the patient profiting from a patient-centered approach is assumed to: (1) appreciate the physicians’ attention to psychosocial needs; (2) like to disclose concerns; (3) prefer to have a sense of partnership; (4) want to be actively involved in decision making. The latter implies the wish to be informed: one cannot be involved in decision making without being well informed.

As it turns out, some patients may be different though. Rudi van Dantzig, a well

Explanations

Patient-centered behavior may not always be comforting. Some patients may thus be less likely to benefit from patient-centered behavior and/or information giving and shared decision making. As outlined above, results of studies seem to indicate that patients with lower education, a worse prognosis as well as a higher level of anxiety, may be more likely to have a lower preference for these communicative approaches. Unfortunately however, the field of communication not only suffers from a

Conclusion

Taking things together, confusing conclusions may have to be drawn. To be patient centered meant to be respectful to patients, and being respectful was thought to imply paying attention to psychosocial issues, to stimulate autonomy and empowerment, among others by giving information and sharing decisions. These elements of patient centeredness were laid down in mission statements and several definitions of the concept.

Empirical evidence, however, turned out to provide a more differentiated

Acknowledgements

I am very grateful for the thoughtful comments to this paper of Jozien Bensing, Ellen Smets and Linda Zandbelt as well as for the latter's help in searching the literature.

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^☆: This paper was presented at the International Conference on Communication in Healthcare, Chicago, USA, 5–8 October 2005.

View full text

Dilemmas in patient centeredness and shared decision making: A case for vulnerability☆

Introduction

Section snippets

Ideology and conceptual issues

Non-supportive findings

Explanations

Conclusion

Acknowledgements

First page preview

Soc Sci Med

Soc Sci Med

Patient Educ Couns

Soc Sci Med

Soc Sci Med

Soc Sci Med

Patient Educ Couns

J Clin Epidemiol

Patient Educ Couns

Patient Educ Couns

Patient Educ Couns

Interventions for providers to promote a patient-centered approach in clinical consultations

Cochrane Database Syst Rev

The impact of patient-centered care on outcomes

J Fam Practice

Essential elements of communication in medical encounters: the Kalamazoo consensus statement

Acad Med

Principles of biomedical ethics

Patient-centered medicine transforming the clinical method

Patient-Centered Medicine. transforming the clinical method

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J Gen Intern Med