In Portugal, a large part of patients still prefers to play a passive role in problem-solving and decision-making related to their health care, especially in life-threatening situations.
This is the conclusion of a study by a group of researchers from the Faculty of Medicine of the University of Porto (FMUP) and CINTESIS – Center for Health Technology and Services Research, published in the British Medical Journal Open.
The team coordinated by Carlos Martins (FMUP/CINTESIS) heard 599 Portuguese patients with ages from 20 to 99 years old (average of 51.9 years), in a representative sample of the national population. The goal was to understand to what extent the Portuguese want to be involved in the medical decision-making process.
The results surprised the researchers due to the low proportion of Portuguese who before different types of clinical situations consider that the decision should be shared between doctor and patient.
“Most patients prefer the doctor to take control in problem-solving and decision making, whether in quality of life or life-threatening diseases or clinical situations. Portuguese patients prefer to play a passive role and want the doctor to decide,” state the authors.
In a life-threatening clinical situation, 66.1% of the Portuguese consider that the doctor should make the decision, with patients taking a passive role. In a non-life-threatening situation, 64.4% of the Portuguese consider that the doctor should make the decision; and in a quality-of-life situation, 55.4% of the Portuguese consider that the doctor should also make the decision.
The researchers also found that taking an active role and sharing decisions with the doctor was more accepted in younger, better educated and employed people.
According to Carlos Martins, this is a sign of evolution “in the way decisions are made during medical consultation. We have been investing more and more, pedagogically and scientifically, in a patient-centered consultation, based on a shared medical decision model, instead of the paternalistic consultation model in which the power of decision rested entirely with the doctor.
For the authors, this study further reinforces the importance of “training physicians to appropriately involve patients in shared decision making.”
“Shared medical decision making does not consist of the simple act of a physician empathetically sharing his or her decision with the patient. A shared medical decision involves much more than that, it involves empowering the patient, so that they understand the benefits and risks of treatment A and treatment B, to jointly decide on the therapeutic option,” he explains.
Choosing a method of contraception is one example. “There are several options. For the woman to choose the one she prefers, it is important that she is empowered, that she understands well the advantages and disadvantages of each method so that she can then make the decision, together with her doctor,” he exemplifies.
The authors point out, however, that additional studies are needed to better understand this reality and that “health literacy will certainly play an important role in this matter”.
This study was authored by Micaela Gregório (first author), Andreia Teixeira, Rosália Páscoa, Sofia Baptista, Rosa Carvalho, and Carlos Martins.