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A Person Centred Approach to Communicating Risk

Posted by plosmedicine on 30 Mar 2009 at 23:40 GMT

Author: susanne mccabe
Position: retired
Institution: n/a
Submitted Date: February 25, 2005
Published Date: February 28, 2005
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

The Department of Health in UK is advocating the Partnership Approach to healthcare. It is in line with cultural expectations, the consequence of recent scandals and the realisation that improvements in care cannot take place without the active involvement of those who have experience of certain conditions and of the way services are run. 'Expert Patients' are an integral part of the team of experts funded by the DoH to develop 'The Medicines Partnership'.
In a Mori poll 40%-50% of persons wanted more and better quality of involvement in health decisions. The 'Medicines Partnership' supports people's wish for health professionals to help them make choices. This includes weighing up of risks of medicines and treatments.'Overall people feel they do not know enough about alternative treatment options and the balance and risks and benefits of the treatment offered'.(Medicines Partnership Consultation Document 2005).
The GMC in it's recently published booklett, 'The Transitional Edition of the New Doctor', also emphasises the need to include people in decision making by 'help(ing) patients to make informed decisions; with patients as partners;recognise that patients are able to make decisions; understand how the patient wants to make decisions...'; use the expertise of patients; show they recognise patients are knowledgeable about themselves and the effect their health has on their daily life.....' It is very much a Person Centred Approach but has no practical advice.
Many people have never experienced such a consultation and all healthcarers will not be committed to developing the approach for various claims that lack of time and resources make it unrealistic; that they themselves do not have the skills; that people do not expect it etc. Unless there is an obligation to give some evidence on file that a person centred consultation has taken place many will never experience it.
A timely project has in fact been set up in Devon by the Medicines partnership ie 'The Patient Self Completed Agenda Form'. This is filled in by the person before the consultation at a GP Pracices in the area.
Many practitioners though as well as 'the public'need training to develop decision making skills. Very often communication of risk and other information is only in verbal form...neither party can hold all the information necessary to form a judgement 'in their head' and the use of aids such as Decision Trees'and hand held computers which can compute values for individuals , would help. I would not put as much emphasis as the author perhaps, on the value of a 'trusting relationship' unless the professional has relevant training in decision making. In the USA I beieve that independant members of Ethics Committees are involved in helping service users to arive at complex decisions. The values of the health worker are therefore not a significant factor
in very much a person centred approach.

References: The Medicines Partnership Operational PLan 2005 - 2006 (On-line)
Data supplemented by the Healthcare Commission patient surveys of Primary Care 2003/4

GMC online 'The New Doctor'.

E-Health Insider January 2005

No competing interests declared.