The Meaning of Patient Involvement and Participation in Health Care Consultations

School of Social and Political Studies, University of Edinburgh, Adam Ferguson Bldg, George Square, EH8 9LL Edinburgh, UK.
Social Science & Medicine (Impact Factor: 2.89). 04/2007; 64(6):1297-310. DOI: 10.1016/j.socscimed.2006.11.002
Source: PubMed


A number of trends, pressures and policy shifts can be identified that are promoting greater patient involvement in health care delivery through consultations, treatments and continuing care. However, while the literature is growing fast on different methods of involvement, little attention has been given so far to the role which patients themselves wish to play, nor even of the conceptual meanings behind involvement or participation. This article reviews the current models of involvement in health care delivery as derived from studies of professional views of current and potential practice, prior to examining the empirical evidence from a large-scale qualitative study of the views and preferences of citizens, as patients, members of voluntary groups, or neither. Individual domiciliary interviews were carried out with 44 people recruited from GP practices in northern England. These respondents were then included in a second phase of 34 focus groups in 6 different localities in northern and southern England, of which 22 were with individuals unaffiliated to any voluntary/community groups, 6 related to local voluntary/community groups with specific interests in health or health care, and 6 related to groups without such specific interests. A final set of 12 workshops with the same samples helped to confirm emergent themes.

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    • "There is empirical evidence that the active involvement of patients in decisions about their treatment plan improves patient satisfaction, adherence to recommended treatments, and health outcomes [3] [4]. Engaging the patient in shared decision making has thus been advocated by health policy makers as the preferred model of doctor-patient consultation [2]. Nevertheless, it is important to acknowledge that not all patients desire to be actively involved during the medical consultation. "
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    ABSTRACT: Objectives: To explore micro-cultural differences in patients' need for information provision, perceived participation in decision making, and related concepts during the doctor-patient consultation between French- and Italian-speaking patients in Switzerland. Methods: In 2012, 153 French- and 120 Italian-speaking patients with chronic low back pain (cLBP) were surveyed on their need for information provision, perceived participation in decision making, cLBP knowledge, psychological empowerment, and trust in their doctor. T-tests and regression analyses with interaction terms were performed. Results: Results show that French- and Italian-speaking patients significantly differed in their participation in decision making, with French-speaking patients reporting higher involvement. Need for information provision was related to empowerment among French- and to trust among Italian-speaking patients. For participation in decision making, trust was the only related concept among French-, and cLBP knowledge among Italian-speaking patients. Significant interaction terms indicate a moderation of micro-cultural background. Conclusion: Findings point towards differences in the relationships between individual patient characteristics (i.e. knowledge, empowerment) and relational doctor-patient characteristics (i.e. trust) and patients' need for information provision and participation in decision making between French- and Italian-speaking patients in Switzerland. Practice implications: Doctors should be aware of these differences when dealing with patients of different micro-cultural backgrounds.
    Patient Education and Counseling 11/2015; DOI:10.1016/j.pec.2015.10.018 · 2.20 Impact Factor
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    • "Deliberation among ordinary community members can raise awareness for common values such as equity (Murphy, 2007). As far as decision power (social dimension) is concerned, the role which lay people themselves wish to acquire has been given rather little attention (Thompson, 2007). However, there are various indications that people often prefer to be heard and to be taken into account in health care decisions, but not to be responsible for decisions others are paid to take (Litva et al., 2002; Rise et al., in press). "
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    ABSTRACT: Lay participation in health care decision making lacks an adequate analysis from an organizational perspective. This article aims to develop conceptual devices to analyze policies and practices and the ways in which these could be further developed. By recapping established frameworks and drawing on theories of professional organizations, four participatory roles and their potential to adapt organizational decisions to internal requirements and external challenges are elaborated. While individual patient participation is widely acknowledged, there is still a lack of systematic approaches to the roles of significant others, patient groups, and the broader community and their implementation within health care organizations.
    Administration &amp Society 09/2015; 47(7):827– 850. DOI:10.1177/0095399713489829 · 0.73 Impact Factor
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    • "These low levels of implementation contrast the range of case studies that illustrate that PPI has clear benefits for service improvement. They also reflect that in practice barriers for the implementation of PPI exist, in particular the still prevalent assumption that patients cannot make a contribution, the threat that PPI poses by potentially challenging established principles of health service organization (e.g. by putting into the public domain data on potential quality problems), the time requirements to make PPI work and the lack and expertise of dedicated coordinators to make the best out of PPI (Han et al., 2013; Wiig et al., 2013; Renedo et al., 2014; Thompson, 2007; Fudge et al., 2008). "
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    ABSTRACT: Purpose - The purpose of this paper is to review how patient and public involvement (PPI) can contribute to quality improvement functions and describe the levels of PPI in quality improvement functions at hospital and departmental level in a sample of European hospitals. Design/methodology/approach - Literature review and cross-sectional study. Findings - PPI takes multiple forms in health care and there is not a single strategy or method that can be considered to reflect best practice. The literature reveals that PPI can serve important functions to support quality improvement efforts. In contrast, the assessment of actual PPI in quality improvement shows that PPI is low. Research limitations/implications - Findings are not representative of hospitals in the EU. Practical implications - A diverse set of methods and tools that can be employed to realize PPI. Service providers should consider PPI at all stages, in particular in setting quality standards and criteria and in evaluating the results. Originality/value - Contextualization of empirical findings with case studies from the literature that inform further practice and research on PPI.
    Journal of Health Organisation and Management 08/2015; 29(5):556-69. DOI:10.1108/JHOM-07-2014-0122 · 0.36 Impact Factor
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