Patient participation

Patient participation, also called shared decision-making, is a process in which both the patient and physician contribute to the medical decision-making process. Health care providers explain treatments and alternatives to patients to provide the necessary resources for patients to choose the treatment option that best aligns with their unique cultural and personal beliefs. Participatory medicine, patient-centered care, and health consumerism are all synonyms for patient participation.

In contrast, the biomedical care system places physicians in a position of authority with patients playing a passive role in care. Physicians instruct patients about what to do, and the patients often follow the physicians' advice.

A general paradigm shift has occurred in which patients are more involved in medical decision-making than before. For example, a recent review of 115 patient participation studies found that the majority of respondents preferred to participate in medical decision-making in only 50% of studies prior to 2000, while 71% of studies after 2000 found a majority of respondents who wanted to participate. Many health agencies, including the American Cancer Society and the American College of Physicians, recommend patient participation in their medical practice guidelines.

The basic premise of patient participation is patient autonomy. The model recognizes that patients have personal values that influence the interpretation of risks and benefits differently from a physician. Frequently, there is more than one option, with no clear choice of which option is best; that occurs when the decision at hand is about a preference-sensitive condition. In certain situations, for example, the physician's point of view may differ from the decision that aligns most with the patient's values, judgments, and opinions. A physician may also be driven by financial incentives such as fee-for-service. Thus, informed consent is at the core of shared decision-making. Without fully understanding the advantages and disadvantages of all treatment options, patients cannot engage in making decisions based on their personal values and beliefs.

There are certain patient characteristics that influence the extent of involvement. Research shows that female patients who are younger and more educated and have a less severe illness than other patients are more likely to participate in medical decisions. That is, an increase in age leads to a decrease in desire to participate, while higher levels of education increase participation levels. However, other research has offered conflicting evidence for the effect of age on level of participation. One study found that age did not inversely relate to participation levels. In addition, numeracy levels may play an important role in patient participation. Recent research has shown that, in general, low-numeracy individuals in both Germany and the United States prefer to play a more passive role than their high-numeracy counterparts. That is, individuals who are not as fluent with numbers and statistics tended to let their physicians make medical decisions without much input from the patients. In general, however, Americans play a more active role in the physician-patient relationship, by performing activities like asking follow-up questions and researching treatment options, than do Germans. Furthermore, research shows that race plays an important role in whether a patient participates. Though black patients report that they participate less in shared decision-making than white patients, studies have shown that black patients desire to participate just as much as their white counterparts and are more likely to report initiating conversation about their health care with their physicians.

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