Patient-focused care, however, is not necessarily the same as physician/patient shared decision mak-ing. Patient preferences for a shared decisionmaking approach or physician-directed consultations were evaluated using patient responses to videos of acted consultations of these two different approach-es. Preference for a directed approach was seen when the illness involved physical rather than psychological symptoms and in subjects > 61 years of age. Preference for a shared approach was associated with higher social class (professional and managerial/ technical) and with subjects who smoked. There were, however, large minorities in these groups favoring the opposite approach. It appears that shared decision making is a distinct entity from patient-focused care, and physicians need to understand their patients’ level of need to be involved in decision making vs being directed and guided at a time when they may feel vulnerable.
If patient-focused care is preferred by most patients, why is it not universally adopted? In clinical practice, there are significant barriers to patient-focused care that need to be overcome.
One of the most fundamental prerequisites for patient-focused care is agreement between patients and physicians on patients’ needs. In a survey-based study, Laine et al found that physicians (74 general internists) and patients (n = 814) scored the following aspects of outpatient care as similarly important: interpersonal skill, office support staff, patient involvement, coordination of care, and office environment. However, the greatest discrepancy was reported for provision of information: patients found this factor far more important than physicians (p < 0.001), and ranked it second vs sixth for physicians. If physicians are underestimating patients’ needs for information, this implies that the quality of the consultation for the patient is likely to be adversely effected.
Similar observations were made in a study of unmet needs as assessed by parents of children with chronic medical conditions, including pulmonary conditions. Parents of 119 children and their physicians from five pediatric practice groups completed surveys regarding the type and level of unmet needs for the children. These needs were organized into four subgroups: information needs, contact needs, counseling needs, and specific help needs.