Patient involvement in decision-making: a cross-sectional study in a Malaysian primary care clinic

Ambigapathy, Ranjini; Chia, Yook Chin; Ng, Chirk Jenn

doi:10.1136/bmjopen-2015-010063

Cited by 41 publications

(43 citation statements)

References 14 publications

(17 reference statements)

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“…This finding was similar to a study carried out at a primary care clinic of a teaching hospital in Kuala Lumpur, which showed that most of the patients attending the clinic (51.9%) preferred SDM, followed by being passive (26.3%) and being active (21.8%) in decision-making. 14 Many studies have reported that most patients preferred SDM as being the most satisfactory. 32 – 34 Before seeing the doctor, the majority of the patients in this study perceived that their role in actual decision-making was similar to their preferences in treatment decision-making.…”

Section: Discussionmentioning

confidence: 99%

“… 23 For ease of analysis, we categorized the active decision-making and SDM as an autonomous role, while the role of passive decision-making remained the same, similar to previous studies. 14 , 24 …”

Section: Methodsmentioning

confidence: 99%

“… 12 Limited studies have been conducted on patients’ preferred role in decision-making in Malaysia. For example, two studies were conducted which considered the association between SDM and the perception of hypertensive patients 13 and the association between SDM and patients attending a primary care clinic 14 for their treatment. Both of these studies showed similar results, with nearly half of the patients preferring SDM, followed by preferring to be passive, and followed by preferring to be active in making treatment decisions.…”

Section: Introductionmentioning

confidence: 99%

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Treatment decision-making among breast cancer patients in Malaysia

Nies¹,

Islahudin²,

Chong³

et al. 2017

PPA

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PurposeThis study investigated breast cancer patients’ involvement level in the treatment decision-making process and the concordance between patients’ and physician’s perspectives in decision-making.Participants and methodsA cross-sectional study was conducted involving physicians and newly diagnosed breast cancer patients from three public/teaching hospitals in Malaysia. The Control Preference Scale (CPS) was administered to patients and physicians, and the Krantz Health Opinion Survey (KHOS) was completed by the patients alone. Binary logistic regression was used to determine the association between sociodemographic characteristics, the patients’ involvement in treatment decision-making, and patients’ preference for behavioral involvement and information related to their disease.ResultsThe majority of patients preferred to share decision-making with their physicians (47.5%), while the second largest group preferred being passive (42.6%) and a small number preferred being active (9.8%). However, the physicians perceived that the majority of patients preferred active decision-making (56.9%), followed by those who desired shared decision-making (32.8%), and those who preferred passive decision-making (10.3%). The overall concordance was 26.5% (54 of 204 patient–physician dyads). The median of preference for information score and behavioral involvement score was 4 (interquartile range [IQR] =3–5) and 2 (IQR =2–3), respectively. In univariate analysis, the ethnicity and educational qualification of patients were significantly associated with the patients’ preferred role in the process of treatment decision-making and the patients’ preference for information seeking (p>0.05). However, only educational qualification (p=0.004) was significantly associated with patients’ preference for information seeking in multivariate analysis.ConclusionPhysicians failed to understand patients’ perspectives and preferences in treatment decision-making. The concordance between physicians’ perception and patients’ perception was quite low as the physicians perceived that more than half of the patients were active in treatment decision-making. In actuality, more than half of patients perceived that they shared decision-making with their physicians.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Treatment decision-making among breast cancer patients in Malaysia

Nies¹,

Islahudin²,

Chong³

et al. 2017

PPA

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“…An SDM approach suggested above is likely to be embraced by patients as a study done in our urban primary care setting showed that half of the patients preferred SDM over paternalism or informed patient roles. 35…”

Section: Box 2 Dual-layer Shared Decision Makingmentioning

confidence: 99%

Shared decision making: A dual‐layer model to tackling multimorbidity in primary care

Lee

Abdullah

et al. 2019

Evaluation Clinical Practice

Self Cite

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It is common for primary care providers (PCPs) to manage complex multimorbidity. When caring for patients with multimorbidity, PCPs face challenges to tackle several issues within a short consultation in order to address patients' complex needs. Furthermore, some PCPs may lack access to a multidisciplinary team and need to manage multimorbidity within the confine of a PCP‐patient partnership only. Instead of attempting to address multiple health issues within a single consultation, it would be more feasible and time effective for PCPs and patients to jointly prioritize the health issue to focus on. Using the Malaysian primary care setting as a case study, a dual‐layer‐shared decision‐making approach is proposed whereby PCPs and patients make decisions on which disease(s) (layer 1) and treatment(s) (layer 2) to prioritize. This dual‐layer model aims to address the challenges of short consultation time and limited healthcare resources by encouraging PCPs and patients to discuss, negotiate, and agree on the decision during the consultation to ensure patients' health needs are addressed.

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“…[2] Patients can be either be passive, co-operative or active and Clinical decision-making models in the light of patient participation can be categorized as paternalistic model, in which patients play a passive role, professional-as-agent model, in which the doctor makes the decision for the patient, informed decision-making model in which necessary information is shared with the patient and he makes the decision at the end and shared decision-making model in which the patient and the doctor are responsible for the final decision. [3] In the Indian health care scenario, the concept of shared decision-making has to be considered in the cultural and literacy aspects. A qualitative study and ethical analysis on Healthcare Decision Making in Rural India, a decade ago brought to light, the glaring differences between shared decision making in the Western world and India.…”

Section: Introductionmentioning

confidence: 99%

Regional Language Support for Patient-inclusive Decision Making in Breast Cancer Pathology Domain

Rani*¹,

Gladis²,

Mammen³

2019

IJRTE

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A Clinical Decision Support system (CDSS) is an application that analyzes data to help healthcare providers to make decisions and improve patient care. Clinicians use the CDSS to perform their routine tasks with computer-assistance. In the past, decision-making using CDSS was primarily oriented towards Clinicians but in recent times, shared decision-making with the patient is advocated. Shared decision-making focuses on encouraging patients to become informed and involved about their health-concerns and make right choices in discussion with expert Clinicians. In India, Breast cancer is the number one killer disease among women. The fast-growing breast cancer patient population demands development of a CDSS for the domain with patient-inclusive features. Medical documents generated in English by Medical practitioners may be understood only by patients with adequate medical knowledge and proficiency in English language. To benefit the regional-language patient population, a CDSS was developed with patient-inclusive features such as Risk assessment questionnaires and Pathology reports presented in Tamil to benefit the regional language-literate patients in the state of Tamilnadu. Translation resources for the domain such as Lexicon and Bilingual Dictionary are generated and used in Machine Translation (MT) of the reports in the CDSS. Translation of Pathology reports is performed by applying Natural Language Processing methods and Phrase-based translation approach and is refined using Synsets. The machine-translation by the CDSS was evaluated by comparing the CDSS output with output from a translation tool Anuvadaksh developed by Department of Information Technology, Government of India, and Google Translate. The outputs were also scrutinized by regional language experts and medical experts. The developed CDSS prototype is a pioneering effort to compile medical language resources for breast cancer pathology domain, and to present details to the patient in a language familiar to her. The regional language support would improve co-operation between the Clinician and patients for shared decision-making and enhance understanding in patients who would otherwise be passive due to the English language barrier. The CDSS with regional language could be used in hospitals in Tamilnadu and the implementation could be extended to other regional languages of India in the future

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Patient involvement in decision-making: a cross-sectional study in a Malaysian primary care clinic

Cited by 41 publications

References 14 publications

Treatment decision-making among breast cancer patients in Malaysia

Treatment decision-making among breast cancer patients in Malaysia

Shared decision making: A dual‐layer model to tackling multimorbidity in primary care

Regional Language Support for Patient-inclusive Decision Making in Breast Cancer Pathology Domain

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