ABSTRACT:This article focuses on patients' participation in decision-making in meetings with healthcare professionals in a healthcare system, based on neoliberal regulations and ideas. Drawing on two constructed empirical cases, primarily from the perspective of patients, this article analyses and discusses the clinical practice around decision-making meetings within a Foucauldian perspective. Patients' participation in decision-making can be seen as an offshoot of respect for patient autonomy. A treatment must be chosen, when patients consult physicians. From the perspective of patients, there is a tendency that healthcare professional to supply the patients with the information that the healthcare professionals think necessary for the patient to make his/her own decision. But patients do not always want to be a 'customer' in the healthcare system; they want to be a patient, consulting an expert for help and advice, which creates resistance to the some parts of the decision-making process. Both professionals and patients are subject to the structural frame of the medical field, formed of both neoliberal framework and medical logic. The decision-making competence in relation to the choice of treatment is placed away from the professionals and seen as belonging to the patient. A 'projectification' of the patient occurs, whereby the patient becomes responsible for his choices in treatment and care and the professionals support him with knowledge, preferences, and alternative views, out of which he must make his own choices, and the responsibility for those choices now and in the future. At the same time there is a tendency towards de-professionalisation. In that light, participation of patients in decision-making can be regarded as a tacit governmentality strategy that shape the location of responsibility between individual and society, and independent patients and healthcare professionals, despite 2 the basically desirable, appropriate and necessary idea of involving patients in their own situations from a humanistic perspective.
This study demonstrates some lack of patient-centred care and an absence of tailored patient AF-related education. Furthermore, the study highlights the need for and importance of active patient involvement.
Aims Patient-reported quality of life and anxiety/depression scores provide important prognostic information independently of traditional clinical data. The aims of this study were to describe: (a) mortality and cardiac events one year after hospital discharge across cardiac diagnoses; (b) patient-reported outcomes at hospital discharge as a predictor of mortality and cardiac events. Design A cross-sectional survey with register follow-up. Methods Participants: All patients discharged from April 2013 to April 2014 from five national heart centres in Denmark. Main outcomes Patient-reported outcomes: anxiety and depression (Hospital Anxiety and Depression Scale); perceived health (Short Form-12); quality of life (HeartQoL and EQ-5D); symptom burden (Edmonton Symptom Assessment Scale). Register data: mortality and cardiac events within one year following discharge. Results There were 471 deaths among the 16,689 respondents in the first year after discharge. Across diagnostic groups, patients reporting symptoms of anxiety had a two-fold greater mortality risk when adjusted for age, sex, marital status, educational level, comorbidity, smoking, body mass index and alcohol intake (hazard ratio (HR) 1.92, 95% confidence interval (CI) 1.52-2.42). Similar increased mortality risks were found for patients reporting symptoms of depression (HR 2.29, 95% CI 1.81-2.90), poor quality of life (HR 0.46, 95% CI 0.39-0.54) and severe symptom distress (HR 2.47, 95% CI 1.92-3.19). Cardiac events were predicted by poor quality of life (HR 0.71, 95% CI 0.65-0.77) and severe symptom distress (HR 1.58, 95% CI 1.35-1.85). Conclusions Patient-reported mental and physical health outcomes are independent predictors of one-year mortality and cardiac events across cardiac diagnoses.
Aim Patient-reported outcome measures (PROMs) may predict poor clinical outcome in patients with heart failure (HF). It remains unclear whether PROMs are associated with subsequent adherence to HF medication. We aimed to determine whether health-related quality of life, anxiety and depression were associated with long-term medication adherence in these patients. Methods and results A national cohort study of Danish patients with HF with three-year follow-up (n = 1,464). PROMs included the EuroQol five-dimensional, five-level questionnaire (EQ-5D-5L), the HeartQoL and the Hospital Anxiety and Depression Scale (HADS). Patient-reported outcomes (PRO) data were linked to demographic and clinical data at baseline, and data on all redeemed prescriptions for angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers/angiotensin receptor neprilysin inhibitors (ACEI/ARB/ARNI), β-blockers and mineralocorticoid receptor antagonists (MRAs) during follow-up. Medication non-adherence was defined as < 80% of proportion of days covered (PDC). In adjusted regression analyses, lower health-related quality of life (EQ-5D and HeartQoL) and symptoms of depression (HADS-D) at discharge were associated with non-adherence. After three years of follow-up, lower health-related quality of life (EQ-5D) was associated with non-adherence for ACEI/ARB/ARNI (adjusted OR 2.78, 95% CI:1.19-6.49), β-blockers (adjusted OR 2.35, 95% CI:1.04-5.29), whereas HADS-D was associated with non-adherence for ACEI/ARB/ARNI (adjusted OR 1.07, 95% CI:1.03-1.11) and β-blockers (adjusted OR 1.06, 95% CI:1.02-1.10). Conclusion Lower health-related quality of life and symptoms of depression were associated with non-adherence across HF medications at one- and three years of follow-up. Person-centred care using PROMs may carry a potential for identifying patients at increased risk of future medication non-adherence.
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