Has patients' involvement in the decision-making process changed over time?

Area of Science:

• General Practice
• Medical Sociology
• Health Communication

Background:

• The doctor-patient relationship has evolved due to societal changes, emphasizing informed decision-making.
• The Medical Treatment Act (MTA) of 1995 legally established the requirement for informed patient consent.

Purpose of the Study:

• To examine changes in patient involvement in medical decision-making over time.
• To identify factors influencing patient involvement and general practitioner (GP) communication regarding Medical Treatment Act (MTA) issues.

Main Methods:

• Comparative analysis of two cross-sectional Dutch National Surveys of General Practice (1987 and 2001).
• Inclusion of data from 16 GPs and 442 patients (1987) and 142 GPs and 2784 patients (2001).
• Videotaped consultations analyzed using Roter's Interaction Analysis System, supplemented by observer and patient/GP questionnaires; statistical analyses included descriptive and multilevel modeling.

Main Results:

• Most patients felt they received important information, but discrepancies existed in decision-making involvement and information on alternative treatments/side-effects.
• GPs demonstrating more affective communication and providing more information increased patient involvement, especially among younger patients.
• By 2001, informed decision-making improved, with more frequent requests for consent, though GPs less often assessed patient understanding.

Conclusions:

• Patient involvement in decision-making has generally increased, but not uniformly across all aspects or patient groups.
• Older patients showed less increase in involvement, suggesting a need to explore their willingness, capability, and methods for encouragement in shared decision-making.