Objectives Empirical literature on patient decision role preferences regarding treatment and screening was reviewed to summarize patients’ role preferences across measures, time and patient population. Methods Five databases were searched from January 1980-December 2007 (1980- 2007 Ovid MEDLINE, Cochrane Database of Systematic Reviews, PsychInfo, Web of Science and PubMed (2005-2007). Eligible studies measured patient decision role preferences, described measures, presented findings as percentages or mean scores and were published in English from any country. Studies were compared by patient population, time of publication, and measure. Results 115 studies were eligible. The majority of patients preferred sharing decisions with physicians in 63% of the studies. A time trend appeared. The majority of respondents preferred sharing decision roles in 71% of the studies from 2000 and later, compared to 50% of studies before 2000. Measures themselves, in addition to patient population influenced the preferred decision roles reported. Conclusion Findings appear to vary with the measure of preferred decision making used, time of the publication and characteristics of the population. Practice implications The role preference measure itself must be considered when interpreting patient responses to a measure or question about a patient's preference for decision roles.

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Objective To evaluate the effects of patient-practitioner interaction on the severity and duration of the common cold. Methods We conducted a randomized controlled trial of 719 patients with new cold onset. Participants were randomized to three groups: no patient-practitioner interaction, “standard” interaction or an “enhanced” interaction. Cold severity was assessed twice daily. Patients randomized to practitioner visits used the Consultation and Relational Empathy (CARE) measure to rate clinician empathy. Interleukin 8 (IL-8) and neutrophil counts were obtained from nasal wash at baseline and 48 hours later. Results Patients’ perceptions of the clinical encounter were associated with reduced cold severity and duration. Encounters rated perfect on the CARE score had reduced severity (Perfect: 223, sub-perfect: 271, p=0.04) and duration (Perfect: 5.89 days, sub-perfect: 7.00 days, p=0.003). CARE scores were also associated with a more significant change in IL-8 (Perfect: mean IL-8 change 1586, sub-perfect: 72, p=0.02) and neutrophil count (Perfect: 49, sub-perfect: 12, p=0.09). Conclusions When patients perceive clinicians as empathetic, rating them perfect on the CARE tool, the severity, duration and objective measures (IL-8 and neutrophils) of the common cold significantly change. Practice Implications This study helps us understand the importance of the perception of empathy in a therapeutic encounter.

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Objective: To assess the feasibility, acceptability, and preliminary impact of a telepharmacy intervention in an underserved, rural asthma patient population. Subjects and Methods: Patients with asthma were randomized to receive either standard care or telephone consultations from pharmacists regarding asthma self-management over a 3-month period. Qualitative interviews were conducted to identify participants' attitudes/ opinions regarding the intervention. Baseline and follow-up surveys assessed asthma control, patient activation, and medication utilization. Results: Ninety-eight adults were recruited (78% accrual); 83 completed the study (15% dropout). Participants reported positive opinions and believed the intervention improved their asthma self-management. The intervention group had significantly higher patient activation compared with the control (p < 0.05). There were no significant between-group differences regarding asthma control. However, within-group analyses of the intervention group showed an improvement in asthma control (p < 0.01) and medication adherence (p < 0.01). No within-group differences were found for the control group. Conclusions: This telepharmacy intervention is feasible and showed indicators of effectiveness, suggesting the design is well suited for a robust study to evaluate its impact in uncontrolled asthma patients. Pharmacists helping patients manage asthma through telecommunications may resolve access barriers and improve care.

BackgroundThe American Diabetes Association recommends a family‐centered approach that addresses each family's specific type 1 diabetes self‐management barriers.ObjectiveTo assess an intervention that tailored delivery of self‐management resources to families' specific self‐management barriers.SubjectsAt two sites, 214 children 8‐16 years old with type 1 diabetes and their parent(s) were randomized to receive tailored self‐management resources (intervention, n = 106) or usual care (n = 108).MethodsOur intervention (1) identified families' self‐management barriers with a validated survey, (2) tailored self‐management resources to identified barriers, and (3) delivered the resources as four group sessions coordinated with diabetes visits. Mixed effects models with repeated measures were fit to A1c as well as parent and child QOL during the intervention and 1 year thereafter.ResultsParticipants were 44% youth (8‐12 years) and 56% teens (13‐16 years). No intervention effect on A1c or QOL was shown, combining data from sites and age groups. Analyzing results by site and age group, post‐intervention A1c for teens at one site declined by 0.06 more per month for intervention teens compared to usual care (P < 0.05). In this group, post‐intervention A1c declined significantly when baseline A1c was >8.5 (−0.08, P < 0.05), with an even larger decline when baseline A1c was >10 (−0.19, P < 0.05). In addition, for these teens, the significant improvements in A1c resulted from addressing barriers related to motivation to self‐manage. Also at this site, mean QOL increased by 0.61 points per month more during the intervention for parents of intervention youth than for usual care youth (P < 0.05).ConclusionsTailored self‐management resources may improve outcomes among specific populations, suggesting the need to consider families' self‐management barriers and patient characteristics before implementing self‐management resources.

Very few RCTs in the field have measures of participation in decision making and at least one health outcome. Moreover, extant studies exhibit little consistency in measurement of these variables, and results are mixed. There is a great need for well-designed, reproducible research on clinically relevant outcomes of patient participation in medical decisions.