American College of Clinical Pharmacy
      Search      Cart
         

ACCP Report - July 2019

President's Column

The Power of Asking Patients “What Matters to You?”

Written by Suzanne Amato Nesbit, Pharm.D., FCCP, BCPS, CPE


When engaged in a patient encounter, we often ask, “What brings you here to see us today?” or “What is the matter with you?” The question is meant to determine what symptom or condition is affecting the patient the most and should thus be addressed. However, such questions do not consider patients holistically or determine how their symptoms fit into the broader context of their lives. By changing the question slightly, we can engage patients in conversations that will forge a partnership between them and us. In their 2012 article “Shared Decision Making – The Pinnacle of Patient-Centered Care,” Drs. Barry and Edgeman-Levitan pose a new question, “What matters to you?”1 This question invites patients to describe and share much more than just their symptoms and a summary of their current conditions. It also offers patients the opportunity to be active participants in their own health care and to participate in shared decision-making. In essence, this question is the foundation for delivering patient-centered care.

The IOM report Crossing the Quality Chasm defines patient-centered care as “care that is respectful of and responsive to individual patient preferences, needs, and values.”2 Patient-centered care ensures that patients’ values help guide clinical decisions. Patients and clinicians need to work together to achieve outcomes. Active patient engagement is key. If we don’t ask what matters to patients, how will we know? The paternalistic view of medicine would say that we already know what patients will say and that we as health care professionals already know what is needed to treat a given problem. However, this viewpoint may discount the patient’s experience with an illness. Moreover, shared decision-making with patients and caregivers, if it occurs at all, does not occur until there is a divergent path in treatment options or often at the end of life.3 Most medical decisions regarding diagnosis and treatment include more than one option, but patients may not be included in these decisions.

Shared decision-making can facilitate optimal, collaborative health care determinations by patients and their clinicians. Patients and caregivers can be provided with complete information related to the risks and benefits of proposed diagnostic and treatment modalities. In turn, patients can express their personal concerns, care priorities, and preferences. The decision reached becomes a shared responsibility of the entire care team, including the patient.

For shared decision-making to be effective in the patient-centered model, patients often require education and tools to help them fully understand the information needed to make an informed judgment. Clinical pharmacists, as members of the patient care team, have an obligation to educate patients about their medications, the pharmacotherapeutic benefits and risks involved, and the intended outcomes of treatment. In the ASHP Foundation’s 2019 pharmacy forecast, 35% of respondents believed it likely that at least one-fourth of those rendering prescribing decisions would consider patient preference over expert consensus or evidence-based guidelines.4 Patients who are empowered by being involved in selecting their medications are much more likely to be adherent. Opportunities exist to develop enhanced collaborations with patients and families – i.e., shared decision-making – that achieve the best medication outcomes. Clinical pharmacists must employ the necessary skills to effectively implement care processes that promote shared decision-making and meaningful partnerships with their patients. We must move away from paternalistic approaches primarily intended to instruct patients to follow professional advice or “rules” and instead develop plans that incorporate patients’ personal values, preferences, and circumstances.

Perceived barriers to changing the rhetoric to “what matters to you?” include clinician concerns that such discussions will take too much time in already brief patient encounters and that the issues most important to patients will not be directly related to their health care, per se. However, research indicates that engaging patients in issues that matter to them may actually save time and yield information essential to clinical care.1 Patients often just want to have some control over what’s happening to them. As clinicians, we must better understand patients’ perceptions of their illnesses.

Why is this important to ACCP members? Because our ability to improve patient outcomes by optimizing medications is hindered if we don’t ask a patient “what matters to you?” Our perceptions of nonadherence may change drastically if we fully understand patients’ preferences for how to receive information, take medications, and address other stressors influencing their health care experience. Opportunity exists for us to provide more useful information that helps create a care plan that patients will both understand and adhere to. Incorporating the question “what matters to you?” into our routine interactions with patients can help us connect and partner with them. A partnership between the patient, the caregiver, and the patient care team is thereby forged. This partnership can also significantly influence our own satisfaction as clinicians.

As ACCP begins its next cycle of strategic planning, we are curious about how a professional organization like ours might better engage patients. How do you involve patients in shared decision-making? How are patients engaged in your own practice and/or your organizations/institutions? How can ACCP involve patients in its own organizational planning? Please let us know your thoughts by contacting us at accp@accp.com.

References

  1. Barry MJ, Edgeman-Levitan S. Shared decision making – the pinnacle of patient-centered care. N Engl J Med 2012;366:780-1.
  2. Institute of Medicine (IOM). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press, 2001.
  3. Waldfogel JM, Battle DJ, Rosen M, et al. Team leadership and cancer end-of-life decision making. J Oncol Pract 2016;12:1135-40.
  4. Vermeulen LC, Eddington ND, Gourdine MA, et al. ASHP Foundation pharmacy forecast 2019: strategic planning advice for pharmacy departments in hospitals and health systems. Am J Health Syst Pharm 2019;76:71-100.