Doctor-Patient Communication and Health Decision-Making in Andalusia. Chronic Patients´ Expectations within the Public Healthcare System in Andalusia
DOI:
https://doi.org/10.35669/revistadecomunicacionysalud.2012.2(2).63-77Keywords:
communication; patient-physician relationship; chronic diseaseAbstract
The purpose of the study was to know about the expectations had by chronic patients
within the Public Healthcare System in Andalusia, concerning communication and
making decisions with the medical professionals who take care of them during the
entire treatment process. A qualitative study was carried out in Andalusia, based on
19 in-depth interviews and 17 focus groups with 154 chronic patients and their
relatives, suffering from seven different types of illness, of which the content was later
analyzed based on the type of disease (pathologies), and the level of care (Primary,
Specialized or Emergency Services). The study shows that patients included in all
healthcare processes want information about their illness. In Primary Care, they value
continued attention, closeness and trust as well as being referred to a proper specialist.
In Specialized Care, they expect to receive trustworthy information, proper tests and
a correct diagnosis, friendly treatment and to be listened to. In the Emergency Room,
lack of tim e and overcrowding disrupt pro per communication. The type of chronic
illness influences patients’ expectations in terms of communication and decision-making.
Communication between patients and med ical personnel and the
decision-making process related to chronic illness are crucial for the improvement of
the quality of healthcare. The type of chronic disease marks different expectations
about the communication and decision-making. The communication and the decision
making in the chronic assistance is a priority to improve the quality of the assistance.
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References
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Bruera, E.; Willey, J.S.; Palmer, J.L. y Rosales, M. (2002). Treatment Decisions for Breast Carcinoma: Patients Preferences and Physician Perceptions. Cancer. Vol. 94, nº 7, pp. 1.076-1.080.
Charles, C.; Gafni, A. y Whelan, T. (1999). Decision-Making in the Physician-Patient Encounter: Revisiting the Shared Treatment Decision-Making Model. Social Science & Medicine. Vol. 49, pp. 651–661.
Charles, C.; Gafni, A. y Whelan, T. (1997). Shared Decision-Making in the Medical Encounter. What does it Mean? (Or it Takes at Least Two to Tango). Social Science & Medicine. Vol. 44, nº 5, pp. 681-692.
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http://www.csalud.junta-andalucia.es/salud/sites/csalud/contenidos/Informacion_General/p_3_p_3_procesos_asistenciales_integrados/pai/diabetes_mellitus_v3?perfil=org. Recuperado el 13 de enero de 2012.
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Curtis, K.; Liabo, K.; Roberts, H. y Barker, M. (2004). Consulted but not Heard: a Qualitative Study of Young People's Views of their Local Health Service. Health Expectations. Vol. 7, pp. 149-156.
Epstein, R.; Alper, B. y Quill, T. (2004). Communicating Evidence for Participatory Decision Making. JAMA. Vol. 291, pp. 2359–2366.
Escudero-Carretero, M.J.; Prieto-Rodríguez, M.A.; Fernández-Fernández, I.; March-Cerdá, J.C. (2006). La relación médico-paciente en el tratamiento de la diabetes tipo I. Un estudio cualitativo. Atención Primaria. Vol. 38, nº 1, pp. 8-18.
Escudero-Carretero, M.J.; Prieto-Rodríguez, M.A.; Fernández-Fernández, I.; March-Cerdá, J.C. (2007). Expectations Held by Type 1 and 2 Diabetes Mellitus Patients and their Relatives: the Importance of Facilitating the Health-Care Process. Health Expectations. Vol. 10, nº 4, pp. 337-349.
Heisler, M.; Bouknight, R.B.; Hayward, R.A. et al. (2002). The Relative Importance of Physician Communication, Participatory Decision Making and Patient Understanding in Diabetes Self-Management. Journal of General Internal Medicine. Vol. 17, nº 4, pp. 243-252.
Ishikawa, H.; Hashimoto, H. y Yano, E. (2006). Patients' Preferences for Decision Making and the Feeling of Being Understood in the Medical Encounter among Patients with Rheumatoid Arthritis. Arthritis Care & Research. Vol. 55, nº 6, pp. 878-883.
Jadad, A.; Rizo, C.A. y Enkin, M.W. (2003). I Am a Good Patient Believe it or Not. British Medical Journal. Vol. 326, pp. 1.293-1.294.
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Kaplowitz, S.A.; Campo, S. y Chiu, W.T. (2002). Cancer Patients´ Desires for Communication of Prognosis Information. Health Communication. Vol. 14, nº 2, pp. 221-241.
Kasper, J.; Legaré, F.; Scheibler, F. y Geiger, F. (2012). Turning Signals into Meaning-Shared Decision Making Meets Communication Theory. Health Expectations. Vol. 15, nº 1, pp. 3-11.
Lown, B.A. (2009). Mutual Influence in Shared Decision Making: a Collaborative Study of Patients and Physicians. Health Expectations. Vol. 12, nº 2, pp. 160-174.
Makoul, G. y Clayman, M.L. (2006). An Integrative Model of Shared Decision Making in Medical Encounters. Patient Education and Counseling. Vol. 60, nº 3, pp. 301-312.
March, J.C.; Prieto, M.A.; Hernán, M. y Solas, O. (1999). Técnicas cualitativas para la investigación en salud pública y gestión de servicios de salud: algo más que otro tipo de técnicas. Gaceta Sanitaria. Vol. 13, nº 4, pp. 312-319.
Matthias, M.S.; Parpart, A.L.; Nyland, K.A.; Huffman, M.A.; Stubbs, D.L.; Sargent, C. et al. (2010). The Patient-Provider Relationship in Chronic Pain Care: Providers’ Perspectives. Pain Medicine. Vol. 11, nº 11, pp. 1.688-1.697.
Mease, P.J.; Arnold, L.M.; Crofford, L.J.; Williams, D.A.; Russell, I.J.; Humphrey, L. et al. (2008). Identifying the Clinical Domains of Fibromyalgia: Contributions from Clinician and Patient Delphi Exercises. Arthritis & Rheumatism. Vol. 59, nº 7, pp. 952-960.
Mercado, F.J.; Alcántara Hernández, E.; Lara Flores, N.; Sánchez, A y Tejada Tayabas, L.M. (2002). La atención médica a la enfermedad crónica: reflexiones sobre los procedimientos metodológicos de un estudio cualitativo. Revista Española de Salud Pública. Vol. 76, pp. 461-471.
Ministerio de Sanidad y Consumo (2006). La Salud de la Población Española. Indicadores de salud. Plan de Calidad para el Sistema Nacional de Salud 2006. Disponible en http://www.msssi.gob.es/estadEstudios/estadisticas/inforRecopilaciones/docs/Indicadores_18_abril_PDF.pdf. Recuperado el 29 mayo 2012.
Müller-Schwefe, G.; Jaksch, W.; Morlion, B.; Kalso, E.; Schäfer, M.; Coluzzi, F. et al. (2011). Make a CHANGE: Optimising Communication and Pain Management Decisions. Current Medical Research & Opinion. Vol. 27, nº 2, pp. 481-488.
Nelson, J.E.; Gay, E.B.; Berman, A.R.; Powell, C.A.; Salazar-Schicchi, J. y Wisnivesky, J.P. (2011). Patients Rate Physician Communication about Lung Cancer. Cancer. Vol. 117, nº 22, pp. 5.212-5.220.
Parker, P.A.; Baile, W.F.; de Moor, C.; Lenzi, R.; Kudelka, A.P. y Cohen, L. (2001). Breaking Bad News about Cancer: Patients´ Preferences for Communication. Journal of Clinical Oncology. Vol. 19, nº 7, pp. 2.049-2.056.
Peterson E.L. (2007): Fibromyalgia-Management of a Misunderstood Disorder. Journal of the American Academy of Nurse Practitioners. Vol. 19, nº 7, pp. 341-348.
Pizarro, A. (2000). El análisis de estudios cualitativos. Atención Primaria. Vol. 25, pp. 42-46.
Pope, C.; Mays, N. (1995). Qualitative Research: Reaching the Parts other Methods Cannot Reach: an Introduction to Qualitative Methods in Health and Health Services Research. British Medical Journal. Vol. 311, pp. 42-45.
Quérin, S.; Clermont, M.J.; Dupré-Gousable, C. y Dalmon, P. (2011). Physician-Patient Communication in Nephrology. Néphrology & Thérapeutique. Vol. 7, nº 4, pp. 201-206.
Rogers, M. y Todd, C. (2002). Information Exchange in Oncology Outpatient Clinics: Source, Valence and Uncertainty. Psycho-Oncology. Vol. 11, nº 4, pp. 336-345.
Stevenson, F.A.; Cox, K.; Britten, N. y Dundar, Y. (2004). A Systematic Review of the Research on Communication between Patients and Health-care Professionals about Medicines: the Consequences for Concordance. Health Expectations. Vol. 7, pp. 235-245.
Stewart, M.; Brown, J.; Donner, A. et al. (2000). The Impact of Patient-Centered Care on Outcomes. Journal of Family Practice. Vol. 49, pp. 796-804.
Swenson, S.L.; Buell, S.; Zettler, P. et al. (2004). Patient-Centered Communication. Do Patient really Prefer It? Journal of General Internal Medicine. Vol. 19, nº 11, pp. 1.069-1.079.
Teursch, C. (2003). Patient-Doctor Communication. Medical Clinics of North America. Vol. 85, nº 5, pp. 1.115-1.145.
Walters, J.A.; Hansen, E.C.; Walters, E.H. y Wood-Baker, R. (2008). Under-Diagnosis of Chronic Obstructive Pulmonary Disease: a Qualitative Study in Primary Care. Respiratory Medicine. Vol. 102, nº 5, pp. 738-743.
Welstand, J.; Carson, A. y Rutherfors, P. (2009). Living with Heart Failure: an Integrative Review. International Journal of Nursing Studies. Vol. 46, nº 10, pp. 1.374-1.385.
Woolf, S.H. (1997). Shared Decision-Making: the Case for Letting Patients Decide which Choice is Best. Journal of Family Practice. Vol. 45, pp. 205–208.
World Health Organization (2011). Noncommunicable Diseases Country Profiles 2011. Disponible en http://www.who.int/nmh/publicationsncd_profiles2011/en/index.html. Recuperado el 29 mayo de 2012.
Zachariae, R.; Pederson, C.G.; Jensen, A.B.; Ehrnrooth, E.; Rossen, P.B. y von der Maase, H. (2003). Association of Perceived Physician Communication Style with Patient Satisfaction, Distress, Cancer-related Self-efficacy, and Perceived Control over the Disease. British Journal
of Cancer. Vol. 88, nº 5, pp. 658-665.
Berger, M. y Muhlhauser, I. (1999). Diabetes Care and Patient-Oriented Outcomes. JAMA. Vol. 281, nº 18, pp. 1.676–1.678.
Bruera, E.; Willey, J.S.; Palmer, J.L. y Rosales, M. (2002). Treatment Decisions for Breast Carcinoma: Patients Preferences and Physician Perceptions. Cancer. Vol. 94, nº 7, pp. 1.076-1.080.
Charles, C.; Gafni, A. y Whelan, T. (1999). Decision-Making in the Physician-Patient Encounter: Revisiting the Shared Treatment Decision-Making Model. Social Science & Medicine. Vol. 49, pp. 651–661.
Charles, C.; Gafni, A. y Whelan, T. (1997). Shared Decision-Making in the Medical Encounter. What does it Mean? (Or it Takes at Least Two to Tango). Social Science & Medicine. Vol. 44, nº 5, pp. 681-692.
Consejería de Salud de la Junta de Andalucía. (2011). Proceso asistencial integrado diabetes mellitus. Disponible en:
http://www.csalud.junta-andalucia.es/salud/sites/csalud/contenidos/Informacion_General/p_3_p_3_procesos_asistenciales_integrados/pai/diabetes_mellitus_v3?perfil=org. Recuperado el 13 de enero de 2012.
Consejería de Salud de la Junta de Andalucía (2007). Proceso asistencial integrado angina estable (dolor torácico). Disponible en
http://www.csalud.junta-andalucia.es/salud/export/sites/csalud/galerias/documentos/p_3_p_3_procesos_asistenciales_integrados/angina_estable/02_definicion_global_angina_estable.pdf Recuperado el 13 de enero de 2012.
Curtis, K.; Liabo, K.; Roberts, H. y Barker, M. (2004). Consulted but not Heard: a Qualitative Study of Young People's Views of their Local Health Service. Health Expectations. Vol. 7, pp. 149-156.
Epstein, R.; Alper, B. y Quill, T. (2004). Communicating Evidence for Participatory Decision Making. JAMA. Vol. 291, pp. 2359–2366.
Escudero-Carretero, M.J.; Prieto-Rodríguez, M.A.; Fernández-Fernández, I.; March-Cerdá, J.C. (2006). La relación médico-paciente en el tratamiento de la diabetes tipo I. Un estudio cualitativo. Atención Primaria. Vol. 38, nº 1, pp. 8-18.
Escudero-Carretero, M.J.; Prieto-Rodríguez, M.A.; Fernández-Fernández, I.; March-Cerdá, J.C. (2007). Expectations Held by Type 1 and 2 Diabetes Mellitus Patients and their Relatives: the Importance of Facilitating the Health-Care Process. Health Expectations. Vol. 10, nº 4, pp. 337-349.
Heisler, M.; Bouknight, R.B.; Hayward, R.A. et al. (2002). The Relative Importance of Physician Communication, Participatory Decision Making and Patient Understanding in Diabetes Self-Management. Journal of General Internal Medicine. Vol. 17, nº 4, pp. 243-252.
Ishikawa, H.; Hashimoto, H. y Yano, E. (2006). Patients' Preferences for Decision Making and the Feeling of Being Understood in the Medical Encounter among Patients with Rheumatoid Arthritis. Arthritis Care & Research. Vol. 55, nº 6, pp. 878-883.
Jadad, A.; Rizo, C.A. y Enkin, M.W. (2003). I Am a Good Patient Believe it or Not. British Medical Journal. Vol. 326, pp. 1.293-1.294.
Kaplan, S.H.; Greenfield, S. y Ware, J.E. Jr (1989). Assessing the Effects of Physician-Patient Interactions on the Outcomes of Chronic Disease. Medical Care. Vol. 27, nº 3 suppl., pp. 110-127.
Kaplowitz, S.A.; Campo, S. y Chiu, W.T. (2002). Cancer Patients´ Desires for Communication of Prognosis Information. Health Communication. Vol. 14, nº 2, pp. 221-241.
Kasper, J.; Legaré, F.; Scheibler, F. y Geiger, F. (2012). Turning Signals into Meaning-Shared Decision Making Meets Communication Theory. Health Expectations. Vol. 15, nº 1, pp. 3-11.
Lown, B.A. (2009). Mutual Influence in Shared Decision Making: a Collaborative Study of Patients and Physicians. Health Expectations. Vol. 12, nº 2, pp. 160-174.
Makoul, G. y Clayman, M.L. (2006). An Integrative Model of Shared Decision Making in Medical Encounters. Patient Education and Counseling. Vol. 60, nº 3, pp. 301-312.
March, J.C.; Prieto, M.A.; Hernán, M. y Solas, O. (1999). Técnicas cualitativas para la investigación en salud pública y gestión de servicios de salud: algo más que otro tipo de técnicas. Gaceta Sanitaria. Vol. 13, nº 4, pp. 312-319.
Matthias, M.S.; Parpart, A.L.; Nyland, K.A.; Huffman, M.A.; Stubbs, D.L.; Sargent, C. et al. (2010). The Patient-Provider Relationship in Chronic Pain Care: Providers’ Perspectives. Pain Medicine. Vol. 11, nº 11, pp. 1.688-1.697.
Mease, P.J.; Arnold, L.M.; Crofford, L.J.; Williams, D.A.; Russell, I.J.; Humphrey, L. et al. (2008). Identifying the Clinical Domains of Fibromyalgia: Contributions from Clinician and Patient Delphi Exercises. Arthritis & Rheumatism. Vol. 59, nº 7, pp. 952-960.
Mercado, F.J.; Alcántara Hernández, E.; Lara Flores, N.; Sánchez, A y Tejada Tayabas, L.M. (2002). La atención médica a la enfermedad crónica: reflexiones sobre los procedimientos metodológicos de un estudio cualitativo. Revista Española de Salud Pública. Vol. 76, pp. 461-471.
Ministerio de Sanidad y Consumo (2006). La Salud de la Población Española. Indicadores de salud. Plan de Calidad para el Sistema Nacional de Salud 2006. Disponible en http://www.msssi.gob.es/estadEstudios/estadisticas/inforRecopilaciones/docs/Indicadores_18_abril_PDF.pdf. Recuperado el 29 mayo 2012.
Müller-Schwefe, G.; Jaksch, W.; Morlion, B.; Kalso, E.; Schäfer, M.; Coluzzi, F. et al. (2011). Make a CHANGE: Optimising Communication and Pain Management Decisions. Current Medical Research & Opinion. Vol. 27, nº 2, pp. 481-488.
Nelson, J.E.; Gay, E.B.; Berman, A.R.; Powell, C.A.; Salazar-Schicchi, J. y Wisnivesky, J.P. (2011). Patients Rate Physician Communication about Lung Cancer. Cancer. Vol. 117, nº 22, pp. 5.212-5.220.
Parker, P.A.; Baile, W.F.; de Moor, C.; Lenzi, R.; Kudelka, A.P. y Cohen, L. (2001). Breaking Bad News about Cancer: Patients´ Preferences for Communication. Journal of Clinical Oncology. Vol. 19, nº 7, pp. 2.049-2.056.
Peterson E.L. (2007): Fibromyalgia-Management of a Misunderstood Disorder. Journal of the American Academy of Nurse Practitioners. Vol. 19, nº 7, pp. 341-348.
Pizarro, A. (2000). El análisis de estudios cualitativos. Atención Primaria. Vol. 25, pp. 42-46.
Pope, C.; Mays, N. (1995). Qualitative Research: Reaching the Parts other Methods Cannot Reach: an Introduction to Qualitative Methods in Health and Health Services Research. British Medical Journal. Vol. 311, pp. 42-45.
Quérin, S.; Clermont, M.J.; Dupré-Gousable, C. y Dalmon, P. (2011). Physician-Patient Communication in Nephrology. Néphrology & Thérapeutique. Vol. 7, nº 4, pp. 201-206.
Rogers, M. y Todd, C. (2002). Information Exchange in Oncology Outpatient Clinics: Source, Valence and Uncertainty. Psycho-Oncology. Vol. 11, nº 4, pp. 336-345.
Stevenson, F.A.; Cox, K.; Britten, N. y Dundar, Y. (2004). A Systematic Review of the Research on Communication between Patients and Health-care Professionals about Medicines: the Consequences for Concordance. Health Expectations. Vol. 7, pp. 235-245.
Stewart, M.; Brown, J.; Donner, A. et al. (2000). The Impact of Patient-Centered Care on Outcomes. Journal of Family Practice. Vol. 49, pp. 796-804.
Swenson, S.L.; Buell, S.; Zettler, P. et al. (2004). Patient-Centered Communication. Do Patient really Prefer It? Journal of General Internal Medicine. Vol. 19, nº 11, pp. 1.069-1.079.
Teursch, C. (2003). Patient-Doctor Communication. Medical Clinics of North America. Vol. 85, nº 5, pp. 1.115-1.145.
Walters, J.A.; Hansen, E.C.; Walters, E.H. y Wood-Baker, R. (2008). Under-Diagnosis of Chronic Obstructive Pulmonary Disease: a Qualitative Study in Primary Care. Respiratory Medicine. Vol. 102, nº 5, pp. 738-743.
Welstand, J.; Carson, A. y Rutherfors, P. (2009). Living with Heart Failure: an Integrative Review. International Journal of Nursing Studies. Vol. 46, nº 10, pp. 1.374-1.385.
Woolf, S.H. (1997). Shared Decision-Making: the Case for Letting Patients Decide which Choice is Best. Journal of Family Practice. Vol. 45, pp. 205–208.
World Health Organization (2011). Noncommunicable Diseases Country Profiles 2011. Disponible en http://www.who.int/nmh/publicationsncd_profiles2011/en/index.html. Recuperado el 29 mayo de 2012.
Zachariae, R.; Pederson, C.G.; Jensen, A.B.; Ehrnrooth, E.; Rossen, P.B. y von der Maase, H. (2003). Association of Perceived Physician Communication Style with Patient Satisfaction, Distress, Cancer-related Self-efficacy, and Perceived Control over the Disease. British Journal
of Cancer. Vol. 88, nº 5, pp. 658-665.
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How to Cite
Danet , Alina, María José Escudero Carretero, María Ángeles Prieto Rodríguez, and Joan Carles March Cerdá. 2012. “Doctor-Patient Communication and Health Decision-Making in Andalusia. Chronic Patients´ Expectations within the Public Healthcare System in Andalusia”. Revista de Comunicación y Salud 2 (2):63-77. https://doi.org/10.35669/revistadecomunicacionysalud.2012.2(2).63-77.
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