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Commentary: The Challenge of Information for Patients
Comentario: El reto de la información a los pacientes
R. Ruiz Morala
a Unidad de Medicina de Familia y Comunitaria de Córdoba, Facultad de Medicina de Córdoba, Spain.
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    "textoCompleto" => "<p class="elsevierStylePara">The need to inform patients and their families appropriately is now one of the principal challenges faced by all physicians&#46; Almost all patients now demand more complete and better quality information&#46; Studies in Spain have noted that elements of consultations which patients value most highly include receiving clear and comprehensible information especially regarding treatment and its effects&#59; reassurance by physicians on matters the patient has questions on<span class="elsevierStyleSup">1</span>&#59; and knowledge about and comprehension of the patient&#180;s problem&#46;<span class="elsevierStyleSup">2</span> One of the main expectations on the part of patients who seek primary care is to receive appropriate information and advice&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">The desire to be better informed might be best understood in the light of new social trends&#58; changes have broken down social and class barriers&#44; and rights are being demanded for minorities and other groups &#40;sexual orientation&#44; ethnic identity&#44; women and consumers&#44; among others&#41;&#46; Greater freedom of expression in all areas&#44; and greater availability of medical information mainly on the Internet&#44; contribute to greater expectations by patients to participate in their own care&#44; especially for chronic illnesses and other&#44; lesser illnesses that make up the majority of cases&#46; In addition&#44; medical ethics is acquiring a central role in patient autonomy&#44; and the physician-patient relationship is coming to be viewed as an act of deliberation and collaboration between both parties&#46; These factors have eroded the traditional view of the physician-patient relationship characterized by the physician&#39;s paternalism and the patient&#39;s lack of information&#46; In the process&#44; some of the more confessable assumptions that underpinned the old model have been overturned&#46; On one hand&#44; the purportedly unbridgeable competence gap made it difficult to provide patients with an appropriate explanation of complex subjects&#44; owing to the physician&#39;s vast expertise and the patient&#39;s lack of suitable background knowledge&#46; In addition&#44; the emotionally charged environment created by illness was assumed to make rational communication and comprehension difficult&#46;</p><p class="elsevierStylePara">However&#44; other much more unsavory factors have also been involved&#46; One such factor was physicians&#39; desire to retain power by controlling information&#46; Work by Ley<span class="elsevierStyleSup">4</span> on the effects of information provided to patients and their recall of this information lent support to this view by emphasizing that the more information given to patients&#44; the less they remembered&#46; The inevitable conclusion reached by a large part of the medical community was that it was not worth it to give patients too much information&#46;</p><p class="elsevierStylePara">This conclusion&#44; however&#44; was refuted in research by Tuckett et al&#44;<span class="elsevierStyleSup">5</span> who found that only 10&#37; of the information was forgotten&#44; in contrast with the 30&#37;-50&#37; figure in Ley&#39;s study&#46; The classic work of Tuckett and colleagues&#44; who studied 1302 consultations&#44;<span class="elsevierStyleSup">5</span> led to important methodological improvements&#46; The most noteworthy of these were the consideration that not all information is of the same importance&#44; and that recalling does not necessarily mean comprehending or agreeing&#46; Their study concluded by offering advice to physicians who wished to inform effectively&#46; Doctors were advised to explore the patient&#39;s ideas and beliefs&#44; negotiate and share an explanatory model&#44; and check the patients&#39; interpretation of and reaction to the information provided&#46; In addition&#44; the information physicians offer should be clear enough for the patient to understand it and to realize when he or she and the physician see things differently&#46; In other words&#44; we should offer more information that makes sense to the patient&#44; not only because this is what patients want and because times change&#44; but also because it allows us to hold consultations that are more cooperative and effective for both&#46;</p><p class="elsevierStylePara">Recent studies in Spain&#44; of which the article by Barca Fern&#225;ndez et al<span class="elsevierStyleSup">6</span> is a part&#44; note that patients currently receive vague&#44; unspecific information that keeps them from coping appropriately with their problem&#44;<span class="elsevierStyleSup">2</span> that physicians do not explain the diagnosis&#44;<span class="elsevierStyleSup">7</span> and that many patients do not understand the information they are given but cannot bring themselves to ask their doctor questions&#46;<span class="elsevierStyleSup">6</span> Another finding of interest reported by Barca Fern&#225;ndez et al is that most of the patients did not participate in decision-making regarding their diagnosis and treatment&#46; This&#44; together with the physicians&#39; lack of concern for their beliefs and preferences concerning the diagnosis and treatment&#44;<span class="elsevierStyleSup">7&#44;8</span> suggests that the quality of the relationship during the consultation remains questionable&#46; As a result there may well be direct effects on the physician&#39;s clinical and advocacy efforts&#46; The results of the studies mentioned earlier do in fact seem to suggest a relationship between low participation on the part of the patient during consultation&#44; lack of interest in the patient as a person&#44; and the fact that information provided to the patient is scarce and definitely inadequate&#46; This probably makes it impossible for the patient to become truly capable of cooperating more fully and more effectively in his or her own health care&#46;</p><p class="elsevierStylePara">The research agenda in this area is wide open&#58; we need larger studies with more sophisticated methods that will give us a more accurate idea of the actual degree and impact of these factors&#44; how they are related&#44; and how they affect the outcome of consultations&#46; We should focus our attention on determining in greater detail what transpires during consultations&#44; and on how to record patients&#39; opinions regarding their relationship with the physician&#46; For example&#44; the study by Barca Fern&#225;ndez et al notes that most patients felt the information they had received to be adequate&#46; However&#44; this does not seem credible in the light of data from this study and an earlier report by Makoul et al&#44;<span class="elsevierStyleSup">9</span> who found an &#34;illusion of competence&#39; in patients who felt that important matters had been discussed when in fact they had not been dealt with at all&#46;</p><p class="elsevierStylePara">Reliable&#44; validated instruments should be developed that can provide direct information on patients&#39; opinions&#44; so that this information can be compared with the opinions expressed in appropriately designed questionnaires or qualitative studies&#44; which are unfortunately rare&#46; Both perspectives would make evaluations of the clinical relationship and its consequences more complete and accurate&#46;</p><p class="elsevierStylePara">We also need to learn more about the information given to patients and their participation in decision-making&#46; For example&#44; how do we actually inform our patients when we do inform them&#63; What techniques do we use&#44; and how effective are they&#63; Does the information we provide them with make sense to them&#63; How and whom do we inform about difficult subjects &#40;cancer and other serious diseases&#41;&#63; Nevertheless&#44; we know that although most patients want more information&#44; not all patients do&#46; We do not know what factors determine this behavior&#44; and we know hardly anything about family influences and information-related factors in the primary care setting in Spain&#46; What do patients&#39; families wish to know about their disease and the care they will need&#63; We do not know what information we should share with patients&#44; especially in cases of serious illness&#46; We lay most of the blame for our mistakes in providing information and our inability to make consultations more cooperative on the lack of time&#44; yet what we lack are studies that investigate these issues&#46;</p><p class="elsevierStylePara">Much remains to be explained regarding the impact of training in these subjects on physicians&#44; and regarding the most effective and practical teaching methods&#46; However&#44; we also need to know how to train patients to obtain more and better quality information from their physicians&#44; and how this affects the physician-patient relationship and the efficacy of consultations&#46; These topics are just a sampling from the vast research agenda in this crucial area of information&#46; But they are topics that primary care professionals should consider in framing our long-overdue response to the challenges these problems pose&#46;</p><p class="elsevierStylePara">Key Points</p><p class="elsevierStylePara">&#42; Physicians should provide patients with more information that makes sense and is clear&#46;</p><p class="elsevierStylePara">&#42; The responsibility to provide information is one of the family physician&#39;s main responsibilities&#46;</p><p class="elsevierStylePara">&#42; The type of information and manner in which it is communicated are related with the patient&#39;s ability to cope with health problems and other consequences of the visit to the physician&#39;s office&#46;</p><p class="elsevierStylePara"> &#42; The research agenda for family physicians concerning these issues is currently as broad as it is ineludible&#46;</p>"
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ISSN: 02126567
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos