What are the essential elements to enable patient participation in medical decision making?
BACKGROUND
Patient participation in shared decision making (SDM) results in increased patient knowledge, adherence, and improved outcomes. Despite the benefits of the SDM model, many patients do not attain the level of participation they desire.


OBJECTIVE
To gain a more complete understanding of the essential elements, or the prerequisites, critical to active patient participation in medical decision making from the patient's perspective.


METHODS
Qualitative study.


METHODS
Individual, in-depth patient interviews were conducted until thematic saturation was reached. Two analysts independently read the transcripts and jointly developed a list of codes.


METHODS
Twenty-six consecutive subjects drawn from community dwelling subjects undergoing bone density measurements.


METHODS
Respondents' experiences and beliefs related to patient participation in SDM.


RESULTS
Five elements were repeatedly described by respondents as being essential to enable patient participation in medical decision making: (1) patient knowledge, (2) explicit encouragement of patient participation by physicians, (3) appreciation of the patient's responsibility/rights to play an active role in decision making, (4) awareness of choice, and (5) time.


CONCLUSIONS
The generalizability of the results is limited by the homogeneity of the study sample.


CONCLUSIONS
Our findings have important clinical implications and suggest that several needs must be met before patients can become active participants in decisions related to their health care. These needs include ensuring that patients (1) appreciate that there is uncertainty in medicine and "buy in" to the importance of active patient participation in decisions related to their health care, (2) understand the trade-offs related to available options, and (3) have the opportunity to discuss these options with their physician to arrive at a decision concordant with their values.
Fraenkel
Liana
L
VA Connecticut Healthcare System, West Haven, CT 06516, USA. liana.fraenkel@yale.edu
McGraw
Sarah
S
D000368:Aged; D002755:Choice Behavior; D003657:Decision Making; D005260:Female; D006801:Humans; D007407:Interviews as Topic / Q000379:methods; D008297:Male; D008875:Middle Aged; D010358:Patient Participation / Q000379:methods*; D010817:Physician-Patient Relations