Article type
Year
Abstract
Background: The importance of patient participation in health care has been increasingly recognised, due to ethical reasons and because it can have positive effects on patient satisfaction, treatment adherence and health outcomes. Objectives: To examine attitudes, satisfaction and practicalities regarding the implementation of shared decision making among patients with chronic skin diseases.
Methods: A telephone survey included 315 patients treated for cutaneous squamous cell carcinoma (SCC) at a large dermatological hospital in Italy. Furthermore, a survey was conducted among 231 consecutive psoriasis patients after routine clinical practice and among a second sample of 171 patients exposed to a decision-board, in order to evaluate the decision-making process and treatment knowledge.
Results: In routine clinical practice, 67.9% of psoriasis patients want to be involved in decision making, 28.4% want to leave decisions entirely to the doctor and 3.7% prefer making decisions alone. Only 17.9% of patients have good knowledge. After exposure to a decision-board, 25.3% of patients have good knowledge. At multivariate analysis, good knowledge increased the likelihood of preferring an active role (RR = 2.21; 95%CI 1.3 to 3.9; p = 0.006). The decision-board only marginally improved knowledge and doctor-patient communication. Among SCC patients, skin cancer knowledge was fair/low for 48.9%. Doctors were the main source of skin cancer information for 24.4% of patients. At multivariable analysis, the likelihood of having skin examinations was associated with a doctor’s advice (OR = 2.29; 95% CI:1.2 to 4.4) and higher knowledge level (OR = 2.05; 95% CI: 1.1 to 3.8).
Conclusions: Large proportions of patients want to participate in decision making, but insufficient patient knowledge can represent a barrier. We found substantial knowledge gaps, highlighting the need of interventions promoting knowledge and prevention. More written or multimedia, high quality information is warranted, particularly for patients with lower education. Nurses and other health professionals could play an important role in improving knowledge and awareness. Training programs for improving doctors’ communication skills are needed and greater emphasis should be placed by healthcare managers on patient participation.
Methods: A telephone survey included 315 patients treated for cutaneous squamous cell carcinoma (SCC) at a large dermatological hospital in Italy. Furthermore, a survey was conducted among 231 consecutive psoriasis patients after routine clinical practice and among a second sample of 171 patients exposed to a decision-board, in order to evaluate the decision-making process and treatment knowledge.
Results: In routine clinical practice, 67.9% of psoriasis patients want to be involved in decision making, 28.4% want to leave decisions entirely to the doctor and 3.7% prefer making decisions alone. Only 17.9% of patients have good knowledge. After exposure to a decision-board, 25.3% of patients have good knowledge. At multivariate analysis, good knowledge increased the likelihood of preferring an active role (RR = 2.21; 95%CI 1.3 to 3.9; p = 0.006). The decision-board only marginally improved knowledge and doctor-patient communication. Among SCC patients, skin cancer knowledge was fair/low for 48.9%. Doctors were the main source of skin cancer information for 24.4% of patients. At multivariable analysis, the likelihood of having skin examinations was associated with a doctor’s advice (OR = 2.29; 95% CI:1.2 to 4.4) and higher knowledge level (OR = 2.05; 95% CI: 1.1 to 3.8).
Conclusions: Large proportions of patients want to participate in decision making, but insufficient patient knowledge can represent a barrier. We found substantial knowledge gaps, highlighting the need of interventions promoting knowledge and prevention. More written or multimedia, high quality information is warranted, particularly for patients with lower education. Nurses and other health professionals could play an important role in improving knowledge and awareness. Training programs for improving doctors’ communication skills are needed and greater emphasis should be placed by healthcare managers on patient participation.