Re: Sharing decisions with patients involves more than being patient-centred
I have a great deal of sympathy for Dr. Thistlethwaite's points. I
was surprised by the results of my research. I had expected to show that
patients generally wanted a more sharing approach. A small qualitative
research project, not reported in this paper, carried out with focus
groups using the videos as a trigger showed a consensus among different
social groups in their attitude towards explanation and the presentation
of treatment options to patients. Generally patients wanted explanation
and treatment options, but also wanted the doctor to choose one of the
options presented. They did not like the idea of being presented with an
unfamiliar smorgasbord of treatments and being invited to choose.
I certainly do not believe my research is the last word on this
subject, but it does suggest that the easy consensus, that decision
sharing is unreservedly good, to which I, along with many of the medical
profession, had come to subscribe may be flawed. Patients I interviewed
were very vocal about the reasons for choosing one or other of the
consultations. It was clear that many wanted the doctor to be 'decisive'
and had no truck with what they saw as 'modern' consultation technique.
Many were appalled that the doctor should ask a patient what they ought to
do with a serious illness suggesting that such an action was
'unprofessional'.
It would be interesting to create a set of video vignettes which
included explanations and treatment options, understandable at the many
different levels to suit the needs of those watching, which offered
patients a choice of a doctor selecting the treatment against one where
the patient was asked to choose. If these could be made suitable to be
shown in a brief period to large numbers of patients it would be ideal.
This would not, however, be an easy task.
Rapid Response:
Re: Sharing decisions with patients involves more than being patient-centred
I have a great deal of sympathy for Dr. Thistlethwaite's points. I
was surprised by the results of my research. I had expected to show that
patients generally wanted a more sharing approach. A small qualitative
research project, not reported in this paper, carried out with focus
groups using the videos as a trigger showed a consensus among different
social groups in their attitude towards explanation and the presentation
of treatment options to patients. Generally patients wanted explanation
and treatment options, but also wanted the doctor to choose one of the
options presented. They did not like the idea of being presented with an
unfamiliar smorgasbord of treatments and being invited to choose.
I certainly do not believe my research is the last word on this
subject, but it does suggest that the easy consensus, that decision
sharing is unreservedly good, to which I, along with many of the medical
profession, had come to subscribe may be flawed. Patients I interviewed
were very vocal about the reasons for choosing one or other of the
consultations. It was clear that many wanted the doctor to be 'decisive'
and had no truck with what they saw as 'modern' consultation technique.
Many were appalled that the doctor should ask a patient what they ought to
do with a serious illness suggesting that such an action was
'unprofessional'.
It would be interesting to create a set of video vignettes which
included explanations and treatment options, understandable at the many
different levels to suit the needs of those watching, which offered
patients a choice of a doctor selecting the treatment against one where
the patient was asked to choose. If these could be made suitable to be
shown in a brief period to large numbers of patients it would be ideal.
This would not, however, be an easy task.
Brian McKinstry
Competing interests: No competing interests