Cultural influences on the physician–patient encounter: The case of shared treatment decision-making

Charles, Cathy; Gafni, Amiram; Whelan, Timothy J.; O’Brien, Mary Ann

doi:10.1016/j.pec.2006.06.018

Cited by 146 publications

(124 citation statements)

References 19 publications

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“…In a conceptual paper, Charles et al [24] discussed the influence of culture on the process of treatment decision-making and, in particular, shared treatment decision-making in the physician-patient encounter. It was noted that the nature of the encounter is influenced by cultural expectations, e.g.…”

Section: Influence Of Culturementioning

confidence: 99%

Participation in medical decision-making across Europe: An international longitudinal multicenter study

et al. 2016

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Background: The purpose of this paper was to examine national differences in the desire to participate in decision-making of people with severe mental illness in six European countries. Methods:The data was taken from a European longitudinal observational study (CEDAR; ISRCTN75841675). A sample of 514 patients with severe mental illness from the study centers in Ulm, Germany, London, England, Naples, Italy, Debrecen, Hungary, Aalborg, Denmark and Zurich, Switzerland were assessed as to desire to participate in medical decision-making. Associations between desire for participation in decision-making and center location were analyzed with generalized estimating equations. Results:We found large cross-national differences in patients' desire to participate in decision-making, with the center explaining 40% of total variance in the desire for participation (p<0.001). Averaged over time and independent of patient characteristics, London (mean=2.27), Ulm (mean=2.13) and Zurich (mean=2.14) showed significantly higher scores in desire for participation, followed by Aalborg (mean=1.97), where scores were in turn significantly higher than in Debrecen (mean=1.56). The lowest scores were reported in Naples (mean=1.14). Over time, desire for participation in decision-making increased significantly in Zurich (b=0.23) and decreased in Naples (b=-0.14). In all other centers, values remained stable.Conclusions: This study demonstrates that patients' desire for participation in decisionmaking varies by location. We suggest that more research attention be focused on identifying specific cultural and social factors in each country to further explain observed differences across Europe.

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Section: Influence Of Culturementioning

confidence: 99%

Participation in medical decision-making across Europe: An international longitudinal multicenter study

et al. 2016

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“…However, it raises the possibility that 'full' engagement (incorporating collaboration, contribution, active participation and emotional investment) could be seen as the desired endpoint and failure to reach that point could negatively reflect on the patient and/or the clinician. It is not known whether this level of engagement is essential, whether there are some circumstances where tolerating rehabilitation may be sufficient, or whether full engagement using this definition is universally applicable or may in fact reflect a Western model of healthcare [70]. Nor is it known if this is feasible in the context of rehabilitation where, for a number of reasons, patients may have difficulty demonstrating engagement due to the effects of the very condition that brought them to rehabilitation.…”

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confidence: 99%

A conceptual review of engagement in healthcare and rehabilitation

Bright

Kayes

Worrall

et al. 2014

Disability and Rehabilitation

179

177

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A conceptual review of engagement in healthcare and rehabilitationPurpose: This review sought to develop an understanding of how engagement in healthcare has been conceptualized in the literature in order to inform future clinical practice and research in rehabilitation. A secondary purpose was to propose a working definition of engagement.Method: EBSCO and SCOPUS databases and reference lists were searched for papers that sought to understand or describe the concept of engagement in healthcare or reported the development of a measure of engagement in healthcare. We drew on a Pragmatic Utility approach to concept analysis.Results: Thirty-one articles met the criteria and were included in the review. Engagement appeared to be conceptualized in two inter-connected ways: as a gradual process of connection between the healthcare provider and patient; and as an internal state which may be accompanied by observable behaviors indicating engagement. Conclusion:Our review suggests engagement to be multi-dimensional, comprising both a coconstructed process and a patient state. While engagement is commonly considered a patient behavior, the review findings suggest clinicians play a pivotal role in patient engagement. This review challenges some understandings of engagement and how we work with patients, and highlights conceptual limitations of some measures. Introduction'Patient engagement' is a term increasingly used in rehabilitation and the broader healthcare context [1]. Several authors have argued the benefits of rehabilitation are limited if the patient is not fully engaged in the process [2,3]. For example, levels of engagement have been associated with improved functional improvement during inpatient rehabilitation and levels of functioning after discharge. Levels of engagement have also been associated with lower levels of depression and with higher levels of affect, adherence and attendance [2,4]. In addition, within clinical rehabilitation practice, the 'engaged patient' is perhaps identified as being the 'desirable patient', one who is easy for providers to work with [5]. On the face of it, these findings suggest that patient engagement is both positive and desirable.While the term 'engagement' is increasingly used in clinical practice and research, there has been relatively little critical exploration of what 'engagement' means and the underpinning concept/s the term may represent. Research of engagement appears to be in its early days, with little consensus on what engagement is, what leads to a patient being perceived as engaged or disengaged or indeed, how engagement occurs. The term engagement is used in multiple ways in the literature, variably referring to patient actions and behaviors such as accessing services [6], retention within services [7,8], enthusiasm [2] and self-management of health conditions [8], or referred to a hospital's provision of health resources and social media usage [9], and to the interaction between the patient and healthcare provider [10].It could be argued that it does not matt...

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“…Studies of patients with medical or surgical conditions suggest that there is significant variability in patient preferences related to shared decision making (Chewning et al 2012;Singh et al 2010). Furthermore, these preferences can be difficult to judge (Kon 2012) and may be culturally mediated (Charles et al 2006). They are not absolute but may shift with the clinical context or type of decision that is being made (Epstein and Gramling 2013).…”

Section: Methodsmentioning

confidence: 99%

The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults

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2015

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Cultural influences on the physician–patient encounter: The case of shared treatment decision-making

Cited by 146 publications

References 19 publications

Participation in medical decision-making across Europe: An international longitudinal multicenter study

Participation in medical decision-making across Europe: An international longitudinal multicenter study

A conceptual review of engagement in healthcare and rehabilitation

The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults

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