Patient participation, also called shared decision making, is "patient involvement in the decision-making process in matters pertaining to health". Usually health care providers explain treatments and alternatives to patients so that patients choose the course of action most consistent with their unique personal and cultural preferences. This concept may be contrasted with the paternalistic model of medical decision making, which was prevalent until the 1990s, in which doctors told patients what to do, and the patients unquestioningly obeyed.
Shared decision making combines evidence-based medicine with the preferences of patients.Many medical decisions are not strictly based on science. Patients have values that emphasize risks and benefits differently from their doctor. There is frequently more than one correct decision. Emerging importance of patient autonomy. Recognition of informed consent as an important component of decision making. Risk-benefit calculation renders not a single absolute recommendation but an assessment of outcome with more or less statistical certainty behind it.
Shared decision making emphasizes the importance of communication in the process of making a decision.
Court cases such as the 1990 Cruzan v. Director, Missouri Department of Health Supreme Court case and the 1976 case of Karen Ann Quinlan have increased the importance of patient autonomy in medical ethics; shared decision making entails giving patients more influence in medical decisions.
Using computers to interact with patients
Interactive software or Internet websites can help interact with the patient. In some studies, Internet-based interventions improve upon usual care whereas in other studies interpersonal interventions are better.
The quality of online decision aids is uncertain.
Tailored, quantitative interaction
A randomized controlled trial of patients at very high risk of coronary events found that use of two clinical prediction rules (http://www.chiprehab.com/CVD/) for predicting coronary events along with tailored feedback, may improve cholesterol values. In this trial, patients were also shown how their calculated risk changed over time and improved in response to changes in the patients' lifestyle changes and pharmacotherapy.
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