Enhance Patient Participation Research Articles

Varieties of silence – a mixed-methods study exploring reasons and justifications for nondisclosure of the use of complementary therapies to physicians in Finland

BackgroundIn health care, two in three users of complementary therapies (CT) stay silent about their CT use. Disclosure of CT use to physicians is important for patient safety, participation, and shared decision-making. Common reasons for CT nondisclosure include patients´ expectations of physicians’ unaccepting response to disclosure, physicians not asking, and patients believing it is unnecessary. This study aimed to increase understanding of patient silence. We investigated how the reasons for nondisclosure of CT use reported by CT users were associated with the frequency of CT disclosure and how these associations and reported justifications to keep silent reflect patient silence among the study participants.MethodsThis mixed-methods study used existing data from the non-probability-based online survey (n = 6802) targeted to CT users among the general population in Finland. A qualitative structured tabular thematic analysis was conducted for the selected 342 brief texts describing the reasons and justification for not telling physicians about CT use. The associations between the frequency of CT disclosure and the reasons for CT nondisclosure were analysed by crosstabulations and binary logistic regression analysis with SPSS (v28).ResultsThree types of patient silence were revealed. Avoidant silence illustrates the respondents coping with the fear of unwanted response from a physician and avoiding the expected negative consequences of CT disclosure. Precautionary silence exemplifies respondents striving to prevent the reoccurrence of previously experienced frustration of wishes to be seen and heard as CT users. Conditional silence portrays the self-confidence of respondents who assessed their need to disclose CT use to physicians on a case-by-case basis.ConclusionsSilence, for some patients, may serve as a way of warding off past and possible future fears and frustrations related to CT disclosure. It is important to recognise different types of patient silence related to CT disclosure to enhance patient participation and shared decision-making in health care. Efforts are needed to provide health policy decision-makers with information about CT users’ lived experiences with CT communication in health care.

623: Enhancing Patient Participation in Healthcare: Comprehensive Approach at a Leading Radiation Clinic

623: Enhancing Patient Participation in Healthcare: Comprehensive Approach at a Leading Radiation Clinic

RehabApp to promote patient participation in the rehabilitation process after HIP replacement: Development and usability study

ObjectiveThis study aims to present the developmental stages of a Mobile App Prototype designed to enhance patient participation in the rehabilitation process after hip replacement. MethodsTo ensure effective interaction between the system and the end user, a User-Centered Design methodology was followed, encompassing three phases: Requirements gathering, Prototyping, and Evaluation. Usability tests were conducted to assess the usability of the developed system. ResultsThe RehabApp for mobile devices was created, and the testing results were positive. Users expressed satisfaction with the outcome, deeming it a valuable tool for their recovery. This outcome demonstrates the high receptiveness of these technologies in the healthcare sector, making it a project that can readily be expanded into other areas of rehabilitation. ConclusionThis study demonstrated the potential of the RehabApp in the rehabilitation process after hip replacement surgery. This accomplishment was realized by ensuring the active participation of patients, potential users, and healthcare professionals throughout the app's development. InnovationThe RehabApp is a mobile application to provide users with all the necessary knowledge, enabling them to undergo a smoother and safer rehabilitation. Feedback from both patients and healthcare professionals played a crucial role in refining the app's features and addressing usability concerns.

Effectiveness of interventions to enhance shared decision-making in wound care: A systematic review.

To explore the effectiveness of interventions to enhance patient participation in shared decision-making in wound care and tissue viability. Caring for people living with a wound is complex due to interaction between wound healing, symptoms, psychological wellbeing and treatment effectiveness. To respond to this complexity, there has been recent emphasis on the importance of delivering patient centred wound care and shared decision-making to personalise health care. However, little is known about the effectiveness of existing interventions to support shared decision-making in wound care. Systematic review of interventional studies to enhance shared decision-making in wound care or tissue viability. This was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines 2020. Interventional primary research studies published in English up to January 2023 were included. Screening, data extraction and quality appraisal were undertaken independently by two authors. Medline, EMBASE, Cochrane Central Register of Controlled Trails (trials database), CINAHL, British Nursing Index (BNI), WorldCat (thesis database), Scopus and registries of ongoing studies (ISRCTN registry and clinicaltrials.gov). 1063 abstracts were screened, and eight full-text studies included. Findings indicate, interventions to support shared decision-making are positively received. Goal or need setting components may assist knowledge transfer between patient and clinician, and could lower short term decisional conflict. However, generally findings within this study had very low certainty due to the inconsistencies in outcomes reported, and the variation and complexity of single and multiple interventions used. Future research on shared decision-making interventions in wound care should include the involvement of stakeholders and programme theory to underpin the interventions developed to consider the complexity of interventions. Patients setting out their needs or goals and exploring patient questions are important and should be considered in clinical care. The review protocol was prospectively registered (PROSPERO database: CRD42023389820). Not applicable as this is a systematic review.

Factors Impacting on Patient-Centered Communication Skills and Their Opportunities to Be Involved in Decision-making From the Perspective of Patients With Cancer, Informal Caregivers, and/or Healthcare Professionals: A Systematic Review.

Active participation of cancer patients and their caregivers in decision-making, along with high-quality communication, is crucial in patient-centered cancer management. Although numerous factors affecting patients' communication and decision-making involvement have been identified, it is still unclear which ones are the most prevalent and critical. To identify factors that contribute to high-quality patient-centered communication and decision-making participation from the perspectives of cancer patients, informal caregivers, and/or healthcare professionals. A systematic review was conducted, using 9 databases to retrieve primary research articles published from 2010 to February 17, 2023, updated on December 13, 2023. Methodological quality was assessed using the Mixed Methods Appraisal Tool (version 18). The socioecological model of communication was utilized as analytical framework for summarizing the results. Fifty-two studies were included. The most frequently reported factors were predominantly articulated at the individual, interpersonal, and societal levels. Although the patients' lack of knowledge and limited language proficiency were the frequent patient-level barriers, the perceived lack of knowledge and lack of training of professionals were the crucial and current professional-level barriers, as reported in studies published in 2016 onward. To circumvent these factors, it is critical to enhance professionals' knowledge, communication skills, and patient relationships. Recognizing barriers and facilitators could help in the development of strategies to overcome these barriers and enhance patient participation in clinical communication. The findings could guide the development of programs to enhance patient-professional communication skills. Further cross-cultural studies are needed to understand culture's impact on communication effectiveness and decision-making participation.

Adapting standardized patient training to improve patients’ understanding and preparedness for health care encounters

ObjectiveTo examine the impact of standardized patient (SP) training on SPs' real-life healthcare encounters and explore whether SP training elements can be adapted to increase actual patients’ understanding, communication and participation in a patient-centered care model. MethodsData were collected from surveys and focus groups with standardized patients and a survey of primary care physicians. Findings were used to create an educational video with pre- and post-viewing surveys of patients’ understanding of engagement strategies and plans to use them in future encounters. ResultsSPs reported medical visits were more productive because of their ability to understand the visit’s framework; crediting their SP training. Patients reported the video will help in planning future medical visits by providing information that increases their understanding of their role in the care process. ConclusionsSPs’ understanding of the visit and its impact on knowledge, skills and affective domains can be transferred to patients in the form of specific strategies that enhance communication and patient participation during medical visits. Practice ImplicationsA brief educational intervention for patients using SPs’ understanding of the medical visit may contribute to enhanced patient participation in future health care encounters and could increase patient engagement in patient-centered models of care.

Adaptive Gait Training of a Lower Limb Rehabilitation Robot Based on Human-Robot Interaction Force Measurement.

The existing fixed gait lower limb rehabilitation robots perform a predetermined walking trajectory for patients, ignoring their residual muscle strength. To enhance patient participation and safety in training, this paper aims to develop a lower limb rehabilitation robot with adaptive gait training capability relying on human-robot interaction force measurement. Firstly, a novel lower limb rehabilitation robot system with several active and passive driven joints is developed, and 2 face-to-face mounted cantilever beam force sensors are employed to measure the human-robot interaction forces. Secondly, a dynamic model of the rehabilitation training robot is constructed to estimate the driven forces of the human lower leg in a completely passive state. Thereafter, based on the theoretical moment from the dynamics and the actual joint interaction force collected by the sensors, an adaptive gait adjustment method is proposed to achieve the goal of adapting to the wearer's movement intention. Finally, interactive experiments are carried out to validate the effectiveness of the developed rehabilitation training robot system. The proposed rehabilitation training robot system with adaptive gaits offers great potential for future high-quality rehabilitation training, e.g., improving participation and safety.

Co-design of an intervention to improve patient participation in discharge medication communication.

Patients can experience medication-related harm and hospital readmission because they do not understand or adhere to post-hospital medication instructions. Increasing patient medication literacy and, in turn, participation in medication conversations could be a solution. The purposes of this study were to co-design and test an intervention to enhance patient participation in hospital discharge medication communication. In terms of methods, co-design, a collaborative approach where stakeholders design solutions to problems, was used to develop a prototype medication communication intervention. First, our consumer and healthcare professional stakeholders generated intervention ideas. Next, inpatients, opinion leaders, and academic researchers collaborated to determine the most pertinent and feasible intervention ideas. Finally, the prototype intervention was shown to six intended end-users (i.e. hospital patients) who underwent usability interviews and completed the Theoretical Framework of Acceptability questionnaire. The final intervention comprised of a suite of three websites: (i) a medication search engine; (ii) resources to help patients manage their medications once home; and (iii) a question builder tool. The intervention has been tested with intended end-users and results of the Theoretical Framework of Acceptability questionnaire have shown that the intervention is acceptable. Identified usability issues have been addressed. In conclusion, this co-designed intervention provides patients with trustworthy resources that can help them to understand medication information and ask medication-related questions, thus promoting medication literacy and patient participation. In turn, this intervention could enhance patients' medication self-efficacy and healthcare utilization. Using a co-design approach ensured authentic consumer and other stakeholder engagement, while allowing opinion leaders and researchers to ensure that a feasible intervention was developed.

Implementation of Virtual Integrative Oncology Shared Medical Appointment Series (VIOSMAS) Within Mixed Diagnosis Population.

Integrative oncology [IO] is sought-after by patients, endorsed by clinical guidelines, and valued within National Cancer Institute Centers. Shared Medical Appointments [SMA] leverage health education and social connection to deliver enhanced patient experience, population health, cost-reduction, and clinician well-being. Integrative Oncology Shared Medical Appointments increase access to integrative medicine but delivering these services via telehealth have not been evaluated. We created, and pilot tested a Virtual Integrative Oncology Shared Medical Appointment Series (VIOSMAS) to assess its feasibility, acceptability, and efficacy at an urban academic teaching hospital. The 7-session hour-long Living Well with and after Cancer series included didactics, multi-disciplinary experiential sessions, and group discussion. Topics included (1) Introduction, (2) Herbs/Botanicals/Fungi, (3) Mindful Movement, (4) Acupuncture, (5) Narratives and Nature, (6) Diet and Culinary Medicine, and (7) Vitamins/Supplements. Virtual visits via telehealth were offered to enhance patient participation during the pandemic. Outcome measures included recruitment, retention, pre/post-series patient survey and qualitative clinician feedback. Between 9/2021 and 4/2023, 72 unique patients were recruited to 5 cohorts and had a total of 332 VIOSMAS visits. A total of 50 patients (69%) attended 4 or more of the 7-session series; 60 (83% were women); patients ranged in age from 28 to 93 years (median 66); 36 (50%) lived outside the city center; the most common cancer diagnoses were breast, lymphoma, and lung cancer. Patients were from diverse demographics. Pre-program, patients reported desiring assistance in addressing diverse symptoms including fatigue, insomnia, pain, gastrointestinal (GI) symptoms, anxiety, and depression. Post-series, patients reported that the VIOSMAS addressed their goals and symptoms; they also reported incorporating recommended lifestyle changes in diet, exercise, sleep, and stress management; they were satisfied with the number of sessions and telehealth format. The participating clinicians reported high levels of satisfaction with VIOSMAS. Revenue to the institution from VIOSMAS exceeded the revenue potential of equivalent time spent for individual visits while supporting extended physician-patient contact. VIOSMAS is feasible for patients and clinicians, addresses patients' symptoms and questions about lifestyle and complementary therapies, and generates more revenue than individual visits. Larger implementation trials with appropriate comparison groups are recommended.

Patient-facing, Semi-automated, solutions to enhance patient participation in measurement-based care practice standards in a tele-mental health specialty clinic for populations at higher risk for self-harm

PurposeCollecting validated surveys that describe symptom severity (measurement based care) during evidence-based psychotherapy is crucial to allow a therapist to tailor the speed and intensity of treatment. COVID clinic closures mandated we create a flexible, remote system to conduct measurement-based care, which was accomplished via RedCap. MethodsRedCap was used to create a semi-automated workflow allowing all clinically-indicated evidence-based surveys (including the PHQ-9) to be delivered via email to patients; with results automatically sent to their provider. Importantly, indications of suicidal ideation were automatically escalated to the provider. ResultsPHQ-9 completion improved, while provider burden for collecting surveys was greatly reduced; however, depending largely upon initial provider-patient ‘training’, overall compliance could still be significantly improved. ConclusionThis workflow gave providers additional information compared to the typical telemedicine environment, and in fact, improved data collection rates over our in-person environment. However, when patients did not complete measures on their own, the burden on providers increased.

Autonomous motion and control of lower limb exoskeleton rehabilitation robot.

Introduction: The lower limb exoskeleton rehabilitation robot should perform gait planning based on the patient's motor intention and training status and provide multimodal and robust control schemes in the control strategy to enhance patient participation. Methods: This paper proposes an adaptive particle swarm optimization admittance control algorithm (APSOAC), which adaptively optimizes the weights and learning factors of the PSO algorithm to avoid the problem of particle swarm falling into local optimal points. The proposed improved adaptive particle swarm algorithm adjusts the stiffness and damping parameters of the admittance control online to reduce the interaction force between the patient and the robot and adaptively plans the patient's desired gait profile. In addition, this study proposes a dual RBF neural network adaptive sliding mode controller (DRNNASMC) to track the gait profile, compensate for frictional forces and external perturbations generated in the human-robot interaction using the RBF network, calculate the required moments for each joint motor based on the lower limb exoskeleton dynamics model, and perform stability analysis based on the Lyapunov theory. Results and discussion: Finally, the efficiency of the APSOAC and DRNNASMC algorithms is demonstrated by active and passive walking experiments with three healthy subjects, respectively.

Patient participation during discharge medication counselling: Observing real-life communication between healthcare professionals and patients

ObjectivesPrevious studies on hospital discharge showed limited patient involvement, despite its positive outcomes. In this study, provider-patient communication used to enhance patient participation during discharge medication counselling was examined. MethodsThis study comprises a qualitative descriptive observational study. Thirty-four discharge consultations were observed, audio recorded and analysed. We conducted a deductive analysis, elaborating on findings from earlier research. We selected themes and underlying codes illustrating professional-patient communication. For every theme, we identified examples to demonstrate its manifestation during discharge medication counselling. We also assessed what information healthcare professionals (HCPs) shared. ResultsHCPs used cues to increase patient participation, e.g. inquired about patient's preferences, showed empathy and support, and verified understanding of information shared. Patient participation occurred through asking questions, and expressing concerns. A central component in discharge medication counselling was the transmission of information from HCPs to patients. This resulted in HCPs taking a leading role. ConclusionsSeveral HCP cues were detected inviting patients to participate in consultations. Some patients participated in discharge medication counselling. This was influenced by timing of discharge consults, the performing HCP and presence of a relative. Practice implicationsHCPs shared a lot of information with patients. However, this does not automatically mean that patients will be able to understand and apply this information. HCPs should understand the importance of using cues to enable patient participation. One example is using the teach-back method for verifying patient understanding. It may also be desirable to ensure that a relative is present when discharge information is offered.

'I feel like they're actually listening to me': a pilot study of a hospital discharge decision-making conversation guide for patients with injection drug use-associated infections.

The prevalence of injection drug use (IDU)-associated infections and associated hospitalizations has been increasing for nearly two decades. Due to issues ranging from ongoing substance use to peripherally inserted central catheter safety, many clinicians find discharge decision-making challenging. Typically, clinicians advise patients to remain hospitalized for several weeks for intravenous antimicrobial treatment; however, some patients may desire other antimicrobial treatment options. A structured conversation guide, delivered by infectious disease physicians, intended to inform hospital discharge decisions has the potential to enhance patient participation in decisions. We developed a conversation guide in order to: (1) investigate its feasibility and acceptability and (2) examine experiences, outcomes, and lessons learned from use of the guide. We interviewed physicians after they each piloted the conversation guide with two patients. We interviewed patients immediately after the conversation and again 4-6 weeks later. Two analysts indexed transcriptions and used the framework method to identify and organize relevant information. We conducted retrospective chart review to corroborate and contextualize qualitative data. Eight patients and four infectious disease physicians piloted the conversation guide. All patients (N = 8) completed antimicrobial treatment. Nearly all participants believed the conversation guide was important for incorporating patient values and preferences. Patients reported an increased sense of autonomy, but felt post-discharge needs could be better addressed. Physician participants identified the guide's long length and inclusion of pain management as areas for improvement. A novel conversation guide to inform hospital discharge decision-making for patients with IDU-associated infections was feasible, acceptable, and fostered the incorporation of patient preferences and values into decisions. While we identified areas for improvement, overall participants believed that this novel conversation guide helped to improve patient care and autonomy.

PATIENT PARTICIPATION IN HEALTHCARE ACTIVITIES: NURSES' AND PATIENTS' PERSPECTIVES IN TAIWAN

Abstract Patient participation in healthcare activities is key to producing successful patient-centered care. However, little is known about both nurses' and patients' perspectives regarding patient participation in East Asia. This paper compared and contrasted perspectives of patient participation in healthcare activities between nurses and patients (age=61.53 ±8.75), using a qualitative study with a purposive sample of 39 nurses and 15 patients. Inclusion criteria for patient participants were: (1) speaking Mandarin Chinese or Taiwanese dialect, (2) aged 20 or older, (3) hospitalized at the unit for at least 3 days, (4) able to provide written informed consent, and (5) well enough to endure 40–50 minutes of individual interview. A semi-structured interview was applied to focus groups for nurses, and to face-to-face interviews for patients to prevent nosocomial infection. Content analysis was utilized to analyze the data, common themes and subthemes were identified showing three similarities in perspectives between nurses and patients—authoritative culture, participation behaviors, and obstacles to participation, as well as two differences—sources of acquiring patient-related health information, and responsible party. Nurses and patients did not entirely view participation in healthcare activities congruently. Relevant clinical practices are also suggested, including respecting patients' autonomy, nurses' using layman’s language for explanations, patients' understanding the meaning behind their participation behaviors, recognizing obstacles faced in enhancing patient participation with adjusted nursing workload, actively providing needed health information, and leading patients to realize that they will be responsible for their health behaviors after discharge.

Patient autonomy in cardiac inpatient rehabilitation—A COVID-19-specific exploratory trend study

BackgroundThe COVID-19 outbreak has changed nearly all societal domains, including medical rehabilitation. Social distancing measures impacted patients as well as health professionals during the rehabilitation process. Enhancing patient participation should not be forgotten during exceptional situations, as restrictive measures are related to the self-determination of patients. AimIn this exploratory trend study, we aimed to examine the association between COVID-19 restrictions with patients’ motivation, their perception of the patient-provider-relationship, their participation in the rehabilitation process and their current state of health at the beginning of their rehabilitation. MethodsAdopting an exploratory approach, we compared data from a convenience sample of two different groups of patients, who stayed at a cardiac rehabilitation clinic at two different time periods: before the COVID-19 lockdown of rehabilitation clinics (n = 128) and after reopening during the COVID-19 period (n = 137). We used questionnaires on motivation for rehabilitation, patient-provider-relationship, patient activation and perceived state of health. We conducted t-tests and regression analysis to determine whether there were differences by gender, age, heart failure status, preferred form of decision-making (shared/not-shared) and time of rehabilitation (before/during COVID-19) related to the outcome variables. ResultsParticipants evaluated the quality of the patient-provider-relationship in a better way after the reopening of the rehabilitation clinics during the COVID-19 period (p < 0.05), their motivation, participation in the rehabilitation process and their current state of health at the beginning of their rehabilitation was comparable to the group before the COVID-19 lockdown of rehabilitation clinics. Differences in scepticism concerning the treatment and the quality of the patient-provider-relationship were related (p < 0.05) to age and the preferred form of decision-making. Differences in active participation were related (p < 0.05) to sex and differences in the perceived state of health (p < 0.05) to a heart failure diagnosis. ConclusionsTreatment providers could use the time patients spend in isolation after arrival to prepare them for virtual goal-setting conversations to enhance patient participation in exceptional situations.

How does patient engagement work in a real-world setting? Recommendations, caveats, and challenges from a psychosocial perspective

ObjectiveTo propose a possible taxonomy for diverse stakeholders outside the healthcare communication field and to promote meaningful patient engagement in healthcare settings. Moreover, to support them in making more coherent policy, strategy, and practice decisions to enhance patient participation in their healthcare systems. DiscussionThis paper is part of the pEACH Position Papers Series and provides a critical and experience-based reflection on patient engagement in different healthcare-related settings. We propose a framework that operationalises actionable patient engagement at the micro-meso-macro levels. Finally, the authors will highlight some “points of attention” that need to be addressed to support patient engagement implementation in healthcare organisations. Conclusion and practice implicationsUnderstanding and systematising the established meanings of patient engagement through a psychosocial lens is critical to addressing the following questions: "how can various health care organisations ensure that authentic patient engagement informs decision-making and strategies", "how can these organisations build authentic connections with their patients", and importantly, "how can patients gain valuable and reliable insights through patient engagement"? Answering these questions can enable key stakeholders to make informed decisions that ensure the quality and effectiveness of patient engagement initiatives in different healthcare settings.

IoT snoring sound detector prototype as a model of future participatory healthcare.

Traditional healthcare is centred around providing in-hospital services using hospital owned medical instruments. The COVID-19 pandemic has shown that this approach lacks flexibility to insure follow-up and treatment of common medical problems. In an alternative setting adapted to this problem, participatory healthcare can be considered centred around data provided by patients owning and operating medical data collection equipment in their homes. In order to trigger such a shift reliable and price attractive devices need to become available. Snoring, as a human sound production during sleep, can reflect sleeping behaviour and indicate sleep problems as an element of the overall health condition of a person. The use of off-the-shelf hardware from Internet of Things platforms and standard audio components allows the development of such devices. A prototype of a snoring sound detector with this purpose is developed. The device, controlled by the patient and with specific snoring recording and analysing functions is demonstrated as a model for future participatory healthcare. Design of monitoring devices following this model could allow market introduction of new equipment for participatory healthcare, bringing a care complementary to traditional healthcare to the reach of patients, and could result in benefits from enhanced patient participation.

Patient participation in healthcare activities: Nurses' and patients' perspectives in Taiwan.

Patient participation in healthcare activities is key to producing successful patient-centered care. However, little is known about both nurses' and patients' perspectives regarding patient participation in East Asia. This paper compared and contrasted perspectives of patient participation in healthcare activities between nurses and patients, using a qualitative study with a purposive sample of 39 nurses and 15 patients. A semi-structured interview was applied to focus groups for nurses, and to face-to-face interviews for patients. Content analysis was utilized to analyze the data, and common themes and subthemes were identified showing three similarities (authoritative culture, participation behaviors, and obstacles to participation), and two differences (sources of acquiring patient-related health information, and responsible party). Nurses and patients did not entirely view participation in healthcare activities congruently. Relevant clinical practices are also suggested, including respecting patients' autonomy, nurses' using layman's language for explanations, patients' understanding the meaning behind their participation behaviors, recognizing obstacles faced in enhancing patient participation with adjusted nursing workload, actively providing needed health information, and leading patients to realize that they will be responsible for their health behaviors after discharge.

Relationship between trust and patient involvement in medical decision-making: A cross-sectional study.

Patients vary in their preferences regarding involvement in medical decision-making. Current research does not provide complete explanation for this observed variation. Patient involvement in medical decision-making has been found to be influenced by various mechanisms, one of which could be patients' trust in physicians. The aim of this study was to examine whether trust in physicians fosters or impairs patient involvement in medical decision-making. This study also aimed to determine to what extent the relationship between trust and preferences regarding decision-making roles was influenced by the sociodemographic characteristics of the patients. We hypothesised that trust can both foster and impair patient involvement in medical decision-making. A survey was sent out to members of the Nivel Dutch Health Care Consumer Panel in February 2016 (response rate = 47%, N = 703). The Wake Forest Physician Trust Scale was used to measure trust. Patient involvement was measured using two items based on the study published by Flynn and colleagues in 2006. Multiple regression analysis was used to analyse the relationship between trust and patient involvement. We found a negative relationship between trust and patient involvement in medical decision-making in men. Women with high trust reported to be more involved in medical decision-making compared to men with high trust. The results suggest that trust impairs involvement in medical decision-making for men but not for women. Further research could provide a more comprehensive explanation of the variation in patient preferences regarding involvement in medical decision-making to further elucidate which underlying mechanisms could enhance patient participation.

Factors influencing patient participation in medication counseling at the community pharmacy: A systematic review.

Findings document that patient participation in pharmacy encounters is associated with favorable outcomes. However, there is a need to understand factors that may enhance or hinder patient engagement and pharmacist counseling behaviors during their medication discussions. This review aims to: (1) identify barriers and facilitators for patient engagement in pharmacy consultations, (2) explore the relationship between patient factors (such as demographics and communication behavior) and subsequent pharmacist counseling behavior. A systematic review of literature using PRISMA guidelines examined studies published in English addressing influences on patient participation and the relationship between patient factors and pharmacist counseling behavior. Four databases were used - PubMed, CINAHL, PsycINFO, and Scopus. Findings were framed thematically within the constructs of Street's Linguistic Model of Patient Participation in Care (LM). Fifty studies from 1983 to 2019, including 37 using self-reported data, were identified. Patient involvement in patient-pharmacist communication was influenced by enabling factors such as patient knowledge, communication skills, and pharmacy environment. Predisposing factors for participation ranged from patients' beliefs and past experiences to demographic characteristics such as gender and age. Pharmacists' participative behavior with patients was positively associated with patients' engagement and perceived patient cues in the conversation. This systematic review identified predictors of patients' engagement in pharmacy encounters drawing on LM framework. Various predisposing factors, enabling factors, and pharmacist' responses impacted patients' willingness to actively participate in medication counseling at community pharmacies. Equally important, studies documented considerable impact by patients on pharmacists' counseling behavior. Pharmacy encounters should no longer be viewed as controlled simply by pharmacists' expertise and agendas. Patient characteristics and factors such as patient question-asking and expectations also appear to be associated with and influence patient-pharmacist interpersonal communication. Additional research needs to address the identified facilitators and barriers to enhance patient participation and pharmacist counseling behavior.