Patient-centered decision making delivers better outcomes

Contextualizing patient needs and circumstances at the point of care improves healthcare outcomes, according to an observational study published on April 16 in the Annals of Internal Medicine.

The study—authored by Saul J. Weiner, MD, University of Illinois at Chicago and colleagues—examined whether patient-centered decision making (PCDM) impacted outcomes more than encounters where physicians paid no attention to patient context.  

For the research, 774 patients surreptitiously audio-record encounters with 139 resident physicians at internal medicine clinics at two Veterans Affairs facilities. Weiner and his team screened the encounters with contextual red flags, such as failure to manage a chronic illness, and any underlying cause of failure of the patient to practice self-care.

Physicians were scored on the basis of whether they identified a contextual factor and adapted the care plan to it. Among the 548 contextual red flags identified, 208 contextual factors were confirmed either when physicians asked questions or patients volunteered information, according to the study. Physician attention to contextual factors varied according to the presenting contextual red flags.

The study looked at available outcome data for 157 contextual factors, of which PCDM was found to address 96. Of these cases, healthcare outcomes improved in 71 percent versus 46 percent of the 61 cases that did not involve PCDM, Weiner and researchers found.

PCDM “can influence patient satisfaction, perceptions of care, shared decision making, and health behaviors,” Hanan J. Aboumatar, MD, MPH, and Lisa A. Cooper, MD, MPH, wrote in an editorial on the study published in the same issue. “The communication process can also have major implications on whether adherence to treatment—a critical pathway to improving—is achieved.”