Engage Patients as Partners in Shared Decision-making

Engaging patients in shared decision-making about their health management is increasingly important to improving health outcomes and quality of life for persons with arthritis and other rheumatic diseases. In shared decision-making, the patient and the provider are partners who share information and determine together the best therapeutic interventions to achieve desired health outcomes and patient goals.

Studies suggest that patients actively involved in health management decisions are more satisfied with their care and have improved functioning and greater commitment to treatment recommendations.^1-4 Fraenkel and McGraw identify five essential elements to enable patient participation in medical decision-making:

1. Patient knowledge;
2. Explicit provider encouragement of patient participation;
3. Appreciation of the patient’s right to be an active partner in decision-making;
4. Patient awareness of choice; and
5. Sufficient time for both the patient and the provider to receive and process information.⁵

Rheumatology health professionals need to go beyond prescribing and providing health services for their patients to empowering patients to become informed decision-makers in managing their disease. Healthcare providers need to work with patients to identify treatments and interventions that fit the individual patient’s values, preferences, goals, and lifestyle. Strategies to engage and empower patients in shared decision-making include:

1. Conveying respect for the patient’s opinions and values;
2. Eliciting the patient’s goals and preferences for managing their disease;
3. Providing patients with adequate information on their disease and treatment options to allow them to make informed decisions about their disease management;
4. Assisting patients to weigh the benefits and risks of treatment options; and
5. Helping patients identify ways to incorporate treatment recommendations into their lives.^6-7

The ARHP is committed to providing health professionals with the knowledge and skills to enhance their professional practice in order to improve health outcomes for persons with rheumatic and musculoskeletal diseases. Visit the ACR Web site, www.rheumatology.org, to download patient education materials and advocacy tools to help you engage and empower your patients to become active partners in managing their disease. In fact, this is the topic of the keynote address at this year’s ARHP Annual Scientific Meeting. In the session, “The Physician, the Patient, the Disease: Why Bother with Patient-Centered Care,” Bernie Seigel, MD, and Amye Leong, MBA, will discuss the benefits of patient-centered care and how to successfully engage patients in managing their disease. I hope you’ll join us for this informative session.

Karen Kerr is president of the ARHP and a pediatric nurse practitioner at Children’s Hospital of Michigan in Detroit. Contact her via e-mail at arhp@rheumatology.org.

References

1. Kjeken I, Dagfinrud H, Mowinckel P, et al. Rheumatology care: involvement in medical decisions, received information, satisfaction with care, and unmet health care needs in patients with ankylosing spondylitis. Arthritis Rheum. 2006;55:394-401.
2. Stewart M, Brown JB, Donner A, et al. The impact of patient-centered care on outcome. J Fam Pract. 2000;49:796-804.
3. Ward MM, Sundaramurthy S, Lotstein D, et al. Participatory patient-physician communication and morbidity in patients with systemic lupus erythematosus. Arthritis Rheum. 2003;49:810-818.
4. Zachariae R, Pedersen CG, Jensen AB, et al. Association of perceived physician communication style with patient satisfaction, distress, cancer-related self-efficacy, and person control over disease. Br J Cancer. 2003;88:658-661.
5. Fraenkel L, McGraw S. What are the essential elements to enable patient participation in medical decision-making? J Gen Intern Med. 2007;22:614-619.
6. Brady TJ. The patient’s role in rheumatology. Curr Opin Rheumatol. 1998;10:146-151.
7. Charles C, Gafni A, Whelan T. Shared decision making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med. 1997;44:681-682.