Patient Involvement in Medical Decision-Making During Diagnostic Consultations of Patients with Parkinson’s Disease

Abstract Introduction: Parkinson’s Disease (PD) is a progressive neurodegenerative disorder which has a big impact on patients’ lives. During diagnostic consultations clinicians inform patients regarding the PD diagnosis and the treatment patients will receive. PD patients report dissatisfaction with the diagnostic consultations, which could be due to a lack of involvement in medical decision-making (MDM). More information about the topics of MDM, about the level of trust in the patients’ clinician and more patient involvement in MDM could therefore improve patient satisfaction. Research on patient involvement in MDM and trust in their clinician was still scarce. However, we think that patient satisfaction could be higher if patient involvement in MDM and trust in their clinician were improved. The first step in researching this was to investigate the MDM topics during diagnostic consultations for PD patients. Specifically, this study aimed to assess the level of patient involvement...Show moreAbstract Introduction: Parkinson’s Disease (PD) is a progressive neurodegenerative disorder which has a big impact on patients’ lives. During diagnostic consultations clinicians inform patients regarding the PD diagnosis and the treatment patients will receive. PD patients report dissatisfaction with the diagnostic consultations, which could be due to a lack of involvement in medical decision-making (MDM). More information about the topics of MDM, about the level of trust in the patients’ clinician and more patient involvement in MDM could therefore improve patient satisfaction. Research on patient involvement in MDM and trust in their clinician was still scarce. However, we think that patient satisfaction could be higher if patient involvement in MDM and trust in their clinician were improved. The first step in researching this was to investigate the MDM topics during diagnostic consultations for PD patients. Specifically, this study aimed to assess the level of patient involvement in MDM during diagnostic consultations and the factors affecting patient involvement. Finally, this study aimed to examine if patients who were more involved in MDM, had higher trust in their clinician. Gaining insight on these topics could empower them to implement more patient involvement and might thus lead to higher satisfaction and patients’ trust in their clinician. Methods: This study was a part of the DiaMove-project which had a prospective observational mixed-methods longitudinal design. Participants (N=26) completed questionnaires regarding characteristics before diagnostic consultations and reported trust in their clinicians (TiOS-sf) afterwards. The first and second diagnostic consultations were video-recorded. Researchers observationally coded topics of medical decisions and measured patient involvement regarding PD medication using the OPTION-12. Statistical analyses consisted of (multiple) regression analyses. Results: Most commonly observed MDM during diagnostic consultations regarding PD concerned whether or not to start PD medication and follow-up appointments. Patients mean involvement in MDM was low (M=14.11; 2.08 – 50.00). The level of patient involvement was higher for women (Cohen’sf 2=.24; p=.02). Age (p=.30) and educational level (p=.66) did not predict patient involvement. Moreover, the mean patient involvement was 4.18 on a scale from 1 to 5, and did not predict patients’ trust in clinicians (p=.90). Conclusion: Clinicians discuss decisions regarding PD medication and follow-up appointments were most frequently discussed during diagnostic consultations. The results suggested that patients’ mean involvement is low in medical decisions regarding PD medication. However, women are more involved. The results of this study should be interpreted cautiously because of a small sample size. It is recommended to repeat this study with a larger sample size. For clinical practice clinicians are advised to involve their patients more in the medical decision-making process.Show less

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Patient Involvement in Medical Decision-Making During Diagnostic Consultations of Patients with Parkinson’s Disease