An overview of patient involvement in healthcare decision-making: a situational analysis of the Malaysian context

Chirk-Jenn Ng,Zarina-Ismail Irmi,Yew-Kong Lee,Julia P Engkasan,Seng-Fah Tong,Ping-Yein Lee,Nik-Sherina Hanafi,Boon-How Chew

doi:10.1186/1472-6963-13-408

Abstract

BackgroundInvolving patients in decision-making is an important part of patient-centred care. Research has found a discrepancy between patients’ desire to be involved and their actual involvement in healthcare decision-making. In Asia, there is a dearth of research in decision-making. Using Malaysia as an exemplar, this study aims to review the current research evidence, practices, policies, and laws with respect to patient engagement in shared decision-making (SDM) in Asia.MethodsIn this study, we conducted a comprehensive literature review to collect information on healthcare decision-making in Malaysia. We also consulted medical education researchers, key opinion leaders, governmental organisations, and patient support groups to assess the extent to which patient involvement was incorporated into the medical curriculum, healthcare policies, and legislation.ResultsThere are very few studies on patient involvement in decision-making in Malaysia. Existing studies showed that doctors were aware of informed consent, but few practised SDM. There was limited teaching of SDM in undergraduate and postgraduate curricula and a lack of accurate and accessible health information for patients. In addition, peer support groups and 'expert patient’ programmes were also lacking. Professional medical bodies endorsed patient involvement in decision-making, but there was no definitive implementation plan.ConclusionIn summary, there appears to be little training or research on SDM in Malaysia. More research needs to be done in this area, including baseline information on the preferred and actual decision-making roles. The authors have provided a set of recommendations on how SDM can be effectively implemented in Malaysia.

Highlights

Involving patients in decision-making is an important part of patient-centred care
The authors met in July 2011 and came to consensus on five key areas, which reflect the condition of patient involvement in the Malaysian healthcare system
Document review of the laws and policies on shared decision-making (SDM) For standards and policies, we reviewed legislations and policies enacted by the Malaysian Medical Council, which is the official body for medical policy, legislation, and regulation in Malaysia

Summary

Introduction

Involving patients in decision-making is an important part of patient-centred care. Research has found a discrepancy between patients’ desire to be involved and their actual involvement in healthcare decision-making. Using Malaysia as an exemplar, this study aims to review the current research evidence, practices, policies, and laws with respect to patient engagement in shared decision-making (SDM) in Asia. Involving patients in decision-making is a good clinical practice and, in some countries, it is imperative for routine patient care [1,2,3,4]. This forms part of patient-centred care and is increasingly considered to be the gold standard of medical care by the public, clinicians, and policy makers [4]. There is a growing interest in SDM globally in terms of “scope (as a component of patientcentred care) and spread (as a component of healthcare everywhere for everyone)” [11]

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Discussion

Conclusion