UR Proposes New Ways to Help Patients Make Decisions

Biggest Hurdle is Explaining Research, Treatment Options

May 19, 2004

          Suppose a patient is faced with whether to continue or stop a treatment. The patient’s values, fears, understanding of science and mathematical odds, and many other factors make the decision complex and the doctor’s input crucial. In today’s issue of The  Journal of the American Medical Association, a team from the University of Rochester Medical Center offers a blueprint for physicians on how to present the facts in a consumer-oriented medical world.

            The JAMA article presents typical dilemmas and provides words that physicians can use to communicate more effectively. It even points out how word choice can be misleading: “There’s a 90 percent chance that it won’t help,” for example, means something different than, “There’s a 10 percent chance it will help.”

           Lead author Ronald M. Epstein, M.D., UR professor of Family Medicine and Psychiatry, also directs the university’s Center to Improve Communications in Health Care. He says no guidelines exist for discussing medical evidence with patients.

            “Informed patients are more likely to participate actively in their care and make wiser decisions,” Epstein says. “Being able to communicate well with patients transforms the relationship from one that is physician-dominated to one that is a real partnership.”

            Epstein presents five steps to fulfilling the needs of patients and doctors:

1.      Understand the patient’s (and family members’) experience and expectations. For example, this is the time to invite family members to be a part of the discussion.

2.      Build Partnership. For example, express empathy (“you might feel uneasy”) and emphasize that medical decisions must be made together, in trust.

         

3.      Provide a Balanced Discussion of Evidence. Patients usually want more information than they receive; this is the time to anticipate unasked questions. Also, discuss the imperfections of medical science and use aids such as graphs or numbers to present research results.

4.      Make a recommendation. Sometimes this comes with the added burden of explaining how a medical dilemma conflicts with a patient’s desire for convenience, or religious or financial concerns.

5.      Check for understanding and agreement. Asking, “Does that make sense to you?” is a good start. Often, it means going back to explore ideas, or providing more medical information.

           Co-authors are: Timothy Quill, M.D., professor of Medicine, Psychiatry and Medical Humanities, and head of the university’s program for Biopsychosocial Studies, and Brian S. Alper, of the University of Missouri-Columbia.

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