Patient-centered care: Ask patients how much involvement they want

Despite the health industry's emphasis on patient-centered care, propelled even faster by the passage of the Affordable Care Act in 2010, research shows little consistency in how physician-patient interactions promote shared and informed decision-making, according to four studies and a commentary published this month in JAMA Internal Medicine.

For example, through their review of more than 2,000 patients treated recently for high blood pressure and cholesterol, prostate and breast cancer screenings and back and knee problems, researchers found that while most doctors discussed with patients the pros and cons of surgeries, they were less likely to discuss options about cancer screenings or medications to treat high blood pressure or cholesterol.

"Each decision has its own dynamic, and it's intriguing that the heart-risk related discussions weren't very good," said Floyd Fowler, senior scientific advisor for the Informed Medical Decisions Foundation in Boston and the study's lead author. However, he noted that doctors may have discussed back and knee surgeries in more detail because they viewed them as more complicated treatments, according to Reuters.

Nonetheless, researchers acknowledged that while most patients do want to play an active role in their medical decision-making, some prefer to defer that responsibility to the doctor.

At the very least, doctors "who aspire to provide patient-centered care" should ask patients about their decision-making preferences directly, concluded another study led by Harlan Krumholz, M.D., of Yale University School of Medicine.

"We think the first thing to do is ask the patient what they'd like to know, how they'd like to learn it and then tell them," agreed Dr. Mack Lipkin, a professor of medicine at the New York University School of Medicine and the Bellevue Hospital Center in New York City, in a related commentary.

To learn more:
- read the article from Reuters
- see the research from JAMA Internal Medicine: Study 1 Study 2, Study 3, Study 4, commentary

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