Abstract
BackgroundPatient involvement in the decision‐making process, especially for chronically ill elderly patients, has become an important element of patient‐centred primary care in many countries, including the Netherlands. This study openly explores different perspectives of patients, informal caregivers and primary care professionals on patient involvement in primary care team interactions.MethodsSixty‐four qualitative semi‐structured interviews with chronically ill elderly patients, informal caregivers and primary care professionals from various disciplines. Underpinned by a phenomenology approach, this study used conventional content analysis for data analysis.ResultsParticipants have different views of the roles of patients and informal caregivers in the primary care team and thus different expectations of the extent and level of patient involvement. Three challenges impact patient involvement in the team: (a) patients feel misunderstood and less involved that they would like when professionals take control, (b) patients have to balance the conflicting opinions of different professionals and (c) informal caregivers act undesirably as team leaders due to their own view of the level of patient involvement.Discussion and conclusionPatient involvement is formed in complex interactions between patients, informal caregivers and multiple professionals whose perspectives and expectations can be misaligned. Recognizing the value of patients and informal caregivers on the team could help professionals to understand them better and thus limit the likelihood of challenges arising in team interactions.
Highlights
This study openly explores different perspectives of patients, informal caregivers and primary care professionals on patient involvement in primary care team interactions
We openly explored the perspectives of patients, informal caregivers and primary care professionals on patient involvement in the decisionmaking process in interactions in primary care teams
This study found three challenges caused by different perspectives and expectations of patient involvement in the primary care team
Summary
In the last two decades, health care has moved from a paternalistic professional-centred model towards a patient-centred care model that tailors care to patients’ needs, values and experiences.[1,2,3] Patient involvement, defined as “enabling patients to take an active role in deciding about and planning their care,” is part of patient-centred care and increasingly pursued in many countries.[4,5] The fast-growing literature on patient involvement in the decision-making process predominantly focuses on exploring factors that influence patient behaviour and active involvement.[6,7,8]The relational aspects of patient involvement are much discussed in the literature.[6,8,9,10] Davis et al show that patient involvement is influenced by the way professionals interact with patients.[8]. This study openly explores different perspectives of patients, informal caregivers and primary care professionals on patient involvement in primary care team interactions. Methods: Sixty-four qualitative semi-structured interviews with chronically ill elderly patients, informal caregivers and primary care professionals from various disciplines. Results: Participants have different views of the roles of patients and informal caregivers in the primary care team and different expectations of the extent and level of patient involvement. Three challenges impact patient involvement in the team: (a) patients feel misunderstood and less involved that they would like when professionals take control, (b) patients have to balance the conflicting opinions of different professionals and (c) informal caregivers act undesirably as team leaders due to their own view of the level of patient involvement. Discussion and conclusion: Patient involvement is formed in complex interactions between patients, informal caregivers and multiple professionals whose perspectives and expectations can be misaligned. Recognizing the value of patients and informal caregivers on the team could help professionals to understand them better and limit the likelihood of challenges arising in team interactions
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