The importance of patient preferences in treatment decisions—challenges for doctors

doi:10.1136/bmj.327.7414.542

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Rebecca E Say, medical student1,
Richard Thomson (richard.thomson@newcastle.ac.uk), professor of epidemiology and public health2

¹Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4HH
²School of Population and Health Sciences (Epidemiology and Public Health), Medical School, Newcastle upon Tyne NE2 4HH

Correspondence to: R Thomson

The expectation that patients will become increasingly involved in making treatment decisions poses new challenges for doctors. This article discusses what these are and how doctors might face them

Introduction

Health professionals are increasingly encouraged to involve patients in treatment decisions, recognising patients as experts with a unique knowledge of their own health and their preferences for treatments, health states, and outcomes.1 2 Increased patient involvement, a result of various sociopolitical changes,^w1 is an important part of quality improvement since it has been associated with improved health outcomes3 ^w1-w9 and enables doctors to be more accountable to the public.

However, this poses challenges for doctors. We discuss these in relation to the competences for shared decision making that have been proposed.4 ^w10

Methods

We made literature searches using Medline, Web of Science, PsychINFO, CINAHL, the Cochrane Library, and HMIC (key words “consumer participation,” “patient participation,” “decision making,” “patient preferences,” “shared decision making,” “patient involvement in decision making”). We also searched references of articles, indexes of key journals, important texts about patient involvement, and key reviews.

We conducted informal interviews with doctors from a range of specialties (general practice, orthopaedics, stroke medicine, accident and emergency, and vascular surgery) and recorded their opinions to provide a focus to this discussion (quotes in italics).

Establishing a partnership

For patients' views about treatment options to be valued and necessary, there must be a partnership between doctor and patient, but establishing one requires both time and certain skills.

“There's not enough time”—The pressure of time is a perpetual challenge; doctors are particularly concerned about the implications of informing patients without allowing extra time for this.5 However, involving patients more in treatment decisions may have no significant effect on consultation length3: adequate discussion at an early stage may allow more succinct discussion later …