Sunday, May 05, 2013

Patient-centered decision making

Patient centered decision making is a core principle of evidence based medicine (EBM). A recent Annals paper looked at patient centered decision making and demonstrated a positive effect on outcomes:
Background: Patient-centered decision making (PCDM) is the process of identifying clinically relevant, patient-specific circumstances and behaviors to formulate a contextually appropriate care plan.

Medicine by central control as is being pushed by many today cannot accommodate patient-specific factors and is thus in conflict with patient-centered decision making and EBM.

More from the article:

Objective: To ascertain whether encounters in which PCDM occurs are followed by improved health care outcomes compared with encounters where there is inattention to patient context.
Design: Patients surreptitiously audio-recorded encounters with their physicians. Medical records of these encounters were then screened for “contextual red flags,” such as deteriorating self-management of a chronic condition, that could reflect such underlying contextual factors as competing responsibilities or loss of social support. When a contextual factor was identified, either as a result of physician questioning or because a patient volunteered information, physicians were scored on the basis of whether they adapted the care plan to it...
Results: Among 548 contextual red flags, 208 contextual factors were confirmed, either when physicians probed or patients volunteered information. Physician attention to contextual factors (both probing for them and addressing them in care plans) varied according to the presenting contextual red flags. Outcome data were available for 157 contextual factors, of which PCDM was found to address 96. Of these, health care outcomes improved in 68 (71%), compared with 28 (46%) of the 61 that were not addressed by PCDM (P = 0.002).

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