Factors constraining patient engagement in implantable medical device discussions and decisions: interviews with physicians

Abstract

ObjectivePatient engagement (PE) is warranted when treatment risks and outcomes are uncertain, as is the case for higher risk medical devices. Previous research found that patients were not engaged in discussions or decisions about implantable medical devices. This study explored physician views about engaging patients in such discussions.DesignQualitative interviews using a basic descriptive approach.SettingCanada.ParticipantsPracticing cardiovascular and orthopaedic physicians.Main outcome measuresLevel, processes and determinants of PE in medical device discussions and decisions.ResultsViews were largely similar among 10 cardiovascular and 12 orthopaedic physicians interviewed. Most said that it was feasible to inform and sometimes involve patients in discussions, but not to partner with them in medical device decision-making. PE was constrained by patient (comfort with PE, technical understanding, physiologic/demographic characteristics, prognosis), physician (device preferences, time), health system (purchasing contracts) and device factors (number of devices on market, comparative advantage). A framework was generated to help physicians engage patients in discussions about medical devices, even when decisions may not be preference sensitive due to multiple constraints on choice.ConclusionsThis study identified that patients are not engaged in discussions or decisions about implantable medical devices. This may be due to multiple constraints. Further research should establish the legitimacy, prevalence and impact of constraining factors, and examine whether and how different levels and forms of PE are needed and feasible.

Patient-centric culture and implications for patient engagement during the COVID-19 pandemic

“…63 Organizational benefits include the development of tools and systems that are more aligned with patients' needs and preferences, 9 simpler and more accessible care pathways and management structures, 9 healthcare professional attitudes that are more favourable to notions of PE and patient-centered care, 64 lower number of admissions in some hospitals, 65 a more cost-efficient health service organization, 13 and improved clinical outcomes. 66 Related to the individual/group and organizational benefits are the pitfalls of not engaging patients in health care activities. Gruman and colleagues (2010) reported that the potential consequences of not engaging patients may include a higher prevalence of preventable medical diseases and errors, lower health and well-being of patients, increased health disparities between groups, and the use of limited healthcare resources inefficiently.…”

Using shared mental models to conceptualize patients as professionals, decision-makers, collaborators, and members of interprofessional healthcare teams

“…This issue is further complicated by the negative attitudes and perceptions of some healthcare professionals that patients lack the knowledge, understanding, and competency to contribute to healthcare activities. 76 Lack of time and resources and negative attitudes towards patients may originate from viewing patients as distinct components of the healthcare system insofar that one group, the conventional healthcare professionals, design and deliver care to another group, the patients, who serve as passive consumers of health services.…”

Conceptual frameworks and degrees of patient engagement in the planning and designing of health services: A scoping review of qualitative studies

“…The acknowledgement of patients as important contributors to the health care system has led to the proliferation of primary research on the barriers, facilitators, impacts, and strategies of PE. [19][20][21][22][23][24][25] As such, there is a need to synthesize the evidence base. There are many published reviews of PE, but they are topic-and context-specific.…”