Patient preferences often ignored in treatment decisions, warn experts

November 8, 2012, British Medical Journal

Patients' preferences are often misinterpreted or ignored in treatment decisions, leading to a "silent misdiagnosis" that is damaging to both doctors and patients, warn experts on BMJ today.

Albert Mulley from The Dartmouth Center for Science in the USA, along with Chris Trimble and Glyn Elwyn, a visiting professor there from Cardiff University in Wales, argue that a doctor cannot recommend the right treatment without understanding how the patient values the trade offs.

Making an accurate remains a source of professional pride for many physicians, say the authors, yet evidence suggests that the problem of "preference " is high.

For example, there are often gaps between what patients want and what doctors think they want. In one study, doctors believed that 71% of patients with rate keeping their breast as a top priority, but the figure reported by patients was just 7%. And in a study of dementia, patients placed substantially less value than doctors believed on the continuation of life with severely declining cognitive function.

Evidence also shows that patients often choose different treatments after they become better informed about the risks and benefits, say the authors. One study found that 40% fewer patients preferred surgery for benign prostate disease once they were informed about the risks of sexual dysfunction.

Ensuring patients' preferences are not misdiagnosed is not as simple as asking the patient what he or she wants, explain the authors. Instead it requires three steps: adopting a mindset of scientific detachment; using data to formulate a provisional diagnosis; and engaging the patient in three steps of shared decision making: team, option and decision talk.

Better diagnosis of patients' preferences is not only the right ethical thing to do but it may also reduce the cost of healthcare, they add, as evidence from trials shows that engaged and informed patients often choose to have less intensive care and to become more careful about having lots of procedures.

More work is needed to understand whether these potential benefits could be realised in healthcare systems, they conclude, "but it is tantalising to consider that budget challenged health systems around the world could simultaneously give what they want and cut costs."

Explore further: In trial, video helps people weigh bariatric surgery pros, cons

Related Stories

In trial, video helps people weigh bariatric surgery pros, cons

April 7, 2011
A video-based decision aid helped severely obese people to make more informed choices about bariatric surgery and reach more certainty about them, according to a trial involving 152 Group Health patients, e-published in Obesity ...

Doctors often don't disclose all possible risks to patients before treatment

August 8, 2012
Most informed consent disputes involve disagreements about who said what and when, not stand-offs over whether a particular risk ought to have been disclosed. But doctors may "routinely underestimate the importance of a small ...

Ask 3 questions, patients urged

August 26, 2011
Asking three simple questions could help patients have more say and better understand their treatment options, according to University research.

Pre-test genetic counseling increases cancer knowledge for BRCA patients

August 15, 2012
(Medical Xpress) -- Researchers at Moffitt Cancer Center have found that when breast cancer patients are offered pre-test genetic counseling before definitive breast cancer surgery, patients exhibited decreases in distress. ...

Recommended for you

Americans are getting more sleep

January 19, 2018
Although more than one in three Americans still don't get enough sleep, a new analysis shows first signs of success in the fight for more shut eye. According to data from 181,335 respondents aged 15 and older who participated ...

Wine is good for you—to a point

January 18, 2018
The Mediterranean diet has become synonymous with healthy eating, but there's one thing in it that stands out: It's cool to drink wine.

Sleep better, lose weight?

January 17, 2018
(HealthDay)—Sleeplessness could cost you when it's time to stand on your bathroom scale, a new British study suggests.

Who uses phone apps to track sleep habits? Mostly the healthy and wealthy in US

January 16, 2018
The profile of most Americans who use popular mobile phone apps that track sleep habits is that they are relatively affluent, claim to eat well, and say they are in good health, even if some of them tend to smoke.

Improvements in mortality rates are slowed by rise in obesity in the United States

January 15, 2018
With countless medical advances and efforts to curb smoking, one might expect that life expectancy in the United States would improve. Yet according to recent studies, there's been a reduction in the rate of improvement in ...

Can muesli help against arthritis?

January 15, 2018
It is well known that healthy eating increases a general sense of wellbeing. Researchers at Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) have now discovered that a fibre-rich diet can have a positive influence ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.