Abstract
ObjectivePatient engagement (PE) is warranted when treatment risks and outcomes are uncertain, as is the case for higher risk medical devices. Previous research found that patients were not engaged in discussions or decisions about implantable medical devices. This study explored physician views about engaging patients in such discussions.DesignQualitative interviews using a basic descriptive approach.SettingCanada.ParticipantsPracticing cardiovascular and orthopaedic physicians.Main outcome measuresLevel, processes and determinants of PE in medical device discussions and decisions.ResultsViews were largely similar among 10 cardiovascular and 12 orthopaedic physicians interviewed. Most said that it was feasible to inform and sometimes involve patients in discussions, but not to partner with them in medical device decision-making. PE was constrained by patient (comfort with PE, technical understanding, physiologic/demographic characteristics, prognosis), physician (device preferences, time), health system (purchasing contracts) and device factors (number of devices on market, comparative advantage). A framework was generated to help physicians engage patients in discussions about medical devices, even when decisions may not be preference sensitive due to multiple constraints on choice.ConclusionsThis study identified that patients are not engaged in discussions or decisions about implantable medical devices. This may be due to multiple constraints. Further research should establish the legitimacy, prevalence and impact of constraining factors, and examine whether and how different levels and forms of PE are needed and feasible.
Highlights
IntroductionPatient engagement (PE) has been defined as patients (and their families or representatives) and health professionals working in active partnership at various levels across the health care system to improve health and health care [1,2,3]
Patient engagement (PE) has been defined as patients and health professionals working in active partnership at various levels across the health care system to improve health and health care [1,2,3]
PE in their own care can vary according to patient circumstances and preferences from receiving information or education to being an active partner in the care team by setting goals and taking part in decisions [1]
Summary
Patient engagement (PE) has been defined as patients (and their families or representatives) and health professionals working in active partnership at various levels across the health care system to improve health and health care [1,2,3]. The definition recognizes that patients can be engaged at the organizational or system level to improve the design of health services. The definition recognizes that patients can be engaged at the level of their own care, sometimes referred to as patient centred care, which is the focus of our study [1,2,3]. PE in their own care can vary according to patient circumstances and preferences from receiving information or education to being an active partner in the care team by setting goals and taking part in decisions [1]. Methods or tools to implement or achieve PE in their own care include, but are not limited to lay summaries, pre-consultation question prompts, decision aids, shared decisionmaking and self-management programmes [1,2,3]
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