User Expectations of Health and Social Care - Essay Example

USER EXPECTATIONS OF HEALTH AND SOCIAL CARE By User Expectations of Health and Social Care Matters of health and social care are not only the responsibility of health professionals but also the patients. Recently, there has been increased involvement from the public and rising demands to be involved in decision making processes about health and care services. Improved relations between patients, decision makers, and health professionals are crucial in improving and generating satisfaction in both health and social care services. Long gone are the days when decision making on health and social care services was the responsibility of only health professionals and other indirect stakeholders such as the government leaving out patients. Involving user groups such as cancer in decision making facilitates formulation of policies that look beyond current models of care leading to establishment of delivery systems that are fit even for the future. However, increased need for involvement is seemingly more vigorous for challenging diseases such as cancer, heart diseases, and HIV- AIDS. This is because these diseases require repetitive specialized care over relatively long periods of time. As such, there is need for user groups to get involved in decision making processes to ensure that the set policies and decisions are favorable to health and care services provided. For example, there have been many efforts to improve health and service delivery systems for cancer patients globally. Some of the most recognizable efforts include establishment of cancer groups and establishment of hospitals fit to handle cancer cases such as hospice centers. The success of cancer care development is deeply rooted in increased user group involvement in matters pertaining to their care and service provision. Involvement and significant influence is attained through inclusion in decision making processes. The concept of involving cancer patients in decision making is an effort towards attainment of high quality care. Since its introduction, the concept of patient involvement has gained global prominence following increased campaigns emphasizing on its efficiency. The main driver of this concept is the need to provide care that is responsive and specific to an individual’s preference, needs, and values. Additionally, the concept of patient involvement ensures that all clinical decisions are guided by individual patient values. Some of the major attributes linked to the patient involvement concept include patient education and empowerment, effective patient communication system, and provision of appropriate care such as emotional support. Effective patient communication system involves people surrounding the patient such as family and friends who are involved in decision making through interactions with care centers. Moreover, communication deals with explaining all possible treatment options and involving patients in decision making regarding the available treatment options. Effective communication allows information exchange, response to emotions, decision making, patient management, and more importantly establishment of healing relationships. These functions of communication integrate to influence patient-clinician interactions hence influencing patient’s health outcomes (Epstein and Street, 2007, p.18). This goes in line with the concept’s main driver since decisions are in correspondence to patient’s preferences, needs and values. Emotional support is also essential since it eliminates the psychological problems connected to cancer such as anxiety and the general mental health. A high quality cancer care delivery system should meet the needs of cancer patients together with their families. This is to say that cancer care systems should support all cancer patients and families more specifically by giving guidance on making informed decisions that are consistent with individual needs, preferences, and values. This implies that a high quality cancer care delivery system requires incorporation of the patient involvement concept. With this in mind, necessity of involving user groups in decision making processes is further cemented and can hence be regarded as highly important. Sepucha, Fowler, and Mulley argued that “quality of a clinical decision, or its patient-centeredness, is the extent to which it reflects the considered needs, values, and expressed preferences of a well-informed patient and is thus implemented” (2004, p.57). This implies that a patient’s involvement in decision making is crucial and thus improves quality of decisions made and consequently the general quality of the cancer care delivery system. Inclusion of patients in decision making processes is seemingly a shift from past trends that saw medical decisions rely heavily on health professionals without much of a concern on the patient’s view and or opinion. Push for patient involvement in decision making is further fueled by the need to attain maximum patient satisfaction. Research studies have shown that patients involved in their own care decision making tend to be more satisfied with care received than those sidelined during decision making (Hibbard and Greene, 2013, p.5). Additionally, satisfaction in care received is a major contributing factor towards speeded and smooth recovery. This is because the patients have an understanding of the goals of treatment, risks involved, expected outcome, and benefits of the particular treatment method agreed upon. Recent studies showed that “70% of patients suffering from metastatic lung and colorectal cancer” did not know that chemotherapy did not guarantee cure (Weeks et al., 2012, p.4). A different survey also revealed that “64% of patients with metastatic lung cancer did not understand that radiation therapy was unlikely to result in a cure” (Chen et al., 2013, p. 4). This implies that patient-clinician discussions are essential to avoid misleading patients and giving unexpected results. Therefore, quality health care is dependent on implementation of the patient involvement concept. Modern day health care practices have shown improvements in relation to patient involvement in decision making. A comparison between past and modern day health services gives a clear reflection of the significant forward steps made in service development. A study carried out in 1999 among 1057 patient encounters with 3552 clinical decisions showed that only 9% were concluded to be informed medical decisions (Braddock et al. 1999, p.1). This low outcome on informed decisions can be attributed to reduced patient involvement in decision making. Recent studies have shown that at least half of the medical decisions made today involve patients (Lee et al. 2012). The increased patient involvement in the recent years can be attributed to the realization of increased success associated with patient involvement in decision making. This implies that patient user group involvement is if an effective strategy of improving health care service quality. Additionally, there are efforts to further facilitate patient involvement through formulation of favorable policies. Some of these policies include concentrating on educating people on the need for involvement in decision making for their care. Additionally, cancer is heavily dependent on mobilization of efforts due to inclusion of other parties other than clinicians and patients. As such, there is need for educating people on the various options of treatment and how to manage them. Moreover, involvement in decision making ensures that the selected option is manageable by the people involved in care provision. Families and friends of cancer patients often have great roles to play in management of cancer due to advancements in cancer treatment and changes in health practice resulting to early discharge from hospitals. This implies that people surrounding the patients have several roles such as drug management and wound care among others in relation to cancer management. Therefore, recent advancements in cancer treatment necessitate education to ensure appropriate care. These advancements also facilitate shared decision making among all people involved in care provision such as friends and family thereby improving cancer care. There have been efforts to improve quality of health care services prompting formulation of some strategies. For instance there are efforts to implement and embrace a program facilitating early planning for the desirable care service an individual would like to receive. This is to say health professionals and patients should come up with an appropriate plan for future steps of treatment in case the patient is unable to make decisions, perhaps, due to disease advancement. Early planning is needed by cancer patients to give a guideline on the preferred life styles during their final weeks and months. This is because it only through early planning that oncologists have an “opportunity to match patients goals with the actual care delivered” (Peppercorn et al., 2011, p. 757). Early planning directives are documented in formal legal documents authorized by state laws since they provide care instructions in case patients become incapacitated hence the inability to make decisions. Improving quality of services is further facilitated by use of decision aids to ensure that patients make informed decisions. Decision aids are tools that give patients information on all possible treatment options for a particular health condition. For example, use of video decision aids have played a huge role in assisting cancer patients to make informed end of life decisions (El-Jawahri et al., 2010, p.5). This implies that measures focusing on increasing patients in decision making play a huge role in improving care delivery. In cancer diagnosis, patient involvement is highly important due to a number of factors. For starters, cancer care is relatively complex and is accompanied by serious health implications. Additionally, cancer care may involve different treatment modalities ranging from chemotherapy to radiation and or surgery. Conduction of such varied treatments may necessitate involvement of different cancer care specialists hence complicating the process further. Available cancer treatment options are heavily dependent on goals of the treatment with focus on decisions such as choosing between increased survival time and improved quality life. This is because the selected treatment goal has implications on the treatment strategy. For example, less aggressive treatments are mainly meant for achieving a high quality life (Gruman, 2013). Additionally, decisions may vary with time since cancer care is a long term process. For example, a person’s decision at the start of the cancer care process may differ during advanced cancer stages. This implies that patient involvement in decision making is essential in cancer care. Secondly, there are gaps in the evidence and information used in decision making processes for cancer care. Although there have been numerous research studies on cancer, supporting evidence on currently used treatment options is relatively limited. Moreover, recent studies on cancer have revealed that most of the medical decisions made in reference to cancer have limited supporting evidence (Villas Boas et al., 2012). Lack of enough supporting evidence also explains numerous challenges faced in dealing with cancer. However, the gap in supporting evidence is arguably greater among underrepresented individuals such as people with comorbidities since there is little inclusion of such groups in clinical trials. Presence of these evidence gaps necessitates patient involvement during cancer care decisions. Patients should be fully informed of these gaps and then allowed to make decisions with guidance from health professionals on the seemingly more appropriate option. Furthermore, cancer decisions are seemingly sensitive due to the outcome of some of the treatment options available. For instance the most common options for treatment of breast cancer are mastectomy or lumpectomy followed by radiation. Presentation of these two options is bound to bring about different choices among different people guided by their preferences despite the fact that both options possess equivalent survival chances. Some women may prefer mastectomy, removal of entire breast, since it seemingly solves the problem fully or in a bid to avoid radiation therapy. Conversely, some women may prefer lumpectomy followed by radiation in order to conserve their breasts (Collins et al. 2009, p.5). This implies that patient preferences influence decision making hence the need to include patients in decision making processes. This is with considerations of the fact that these treatments have impacts on the future. However, patient involvement has been derailed by a number of factors such as low literacy levels in relation to health care among others. For example, cancer diagnosis is accompanied by complexities especially focusing on treatment options and this may hinder active patient involvement in decision making. As such, many patients opt to leave decision making solely to clinicians yet the decision made may not necessarily concur with the patient’s values, preferences and needs. Additionally, cancer diagnosis process is accompanied by extreme emotional repercussions that may at times hinder patients’ active involvement. This mainly affects the levels of information provided by the patient and may also lead to poor decision making. Involvement in decision making may also be hindered by deliberate avoidance to engage in patient-clinician discussions due to an integration of cultural and personality factors. This refers to scenarios where there is limited engagement among a certain group of people sharing common attributes. For example, older adults may be reluctant to asking questions due to the notion that it is wrong to question the authority of clinicians or that it is wrong to engage in decisions revolving around their health matters (Hoffman, 2004). This is mainly influenced by cultural values although personality aspects may also influence such a decision. Moreover, current reimbursement systems do not prompt health professionals to engage in shared decision making processes with the patients. This implies that there is limited focus on involving patients in the decision making process and it is seemingly the role of the clinician to make an appropriate decision. Furthermore, there is little or no training for health professionals on communication thereby posing challenges in identifying and addressing various patient’s informational and emotional needs. As a result, some patients may find it difficult to engage in discussions pertaining available care options (Frosch, 2012). This explains the communication gap in care service delivery since neither of the parties involved has the necessary communication skills. Lack of effective communication skills may also hinder discussions due to language barrier especially where a clinician uses medical terms, jargon, that are not understandable to the patient. This might overwhelm the patient causing reduced concentration and consequently ineffective communication. Conclusively, the 21st century has seen major improvements in relation to involvement of user groups such as cancer in their service development. Involving user groups has mainly been done by including people in decision making processes during disease diagnosis. This entails patient –clinician discussions on different matters pertaining to the disease at hand. For example, in cancer treatment, patients discuss possible treatment options with their health professionals to ensure quality service delivery. Quality service delivery is guided by attributes ensuring that the selected treatment option is in correspondence with the patient’s preferences, values and needs. This has further been enforced by such efforts as formulation of an early planning program that ensures patient preferences are catered for even in inability to make decisions. This program among other efforts have improved service delivery drawing a conclusion that user group involvement is important in health care service delivery systems. Works Cited Braddock, H, Edwards, A, Hasenberg, M, Laidley, L, & Levinson, W 1999, ‘Informed decision making in outpatient practice: Time to get back to basics’, Journal of the American Medical Association, 282(24), pp. 2313–2320. Chen, B, Cronin, A, Weeks, C, Chrischilles, A, Malin, J, Hayman, A, & Schrag, D 2013, ‘Expectations about the effectiveness of radiation therapy among patients with incurable lung cancer’, Journal of Clinical Oncology, 31(21), pp. 2730–2735. Collins, D, Moore, P, Clay, F, Kearing, A, OConnor, M, Llewellyn-Thomas, A, Barth, J, & Sepucha, K 2009, ‘Can women with early-stage breast cancer make an informed decision for mastectomy’, Journal of Clinical Oncology, 27(4), pp. 519–525. El-Jawahri, A, Podgurski, M, Eichler, F, Plotkin, R, Temel, S, Mitchell, L, Chang, Y, Barry, J, & Volandes, E 2010, ‘Use of video to facilitate end-of-life discussions with patients with cancer: A randomized controlled trial’, Journal of Clinical Oncology, 28(2), pp. 305–310. Epstein, R, & Street, R 2007, ‘Patient-centered communication in cancer care: Promoting healing and reducing suffering’, National Cancer Institute. Frosch, L, May, G, Rendle, A, Tietbohl, C, & Elwyn, G 2012, ‘Authoritarian physicians and patients fear of being labeled “difficult” among key obstacles to shared decision making’, Health Affairs, 31(5), pp. 1030–1038. Gruman, C 2013, ‘An accidental tourist finds her way in the dangerous land of serious illness’, Health Affairs, 2(2), pp. 427–431. Hibbard, H, & Greene, J 2013, ‘What the evidence shows about patient activation: Better health outcomes and care experiences; fewer data on costs’, Health Affairs, 32(2), pp. 207–214. Hoffman, B, 2004, A cancer survivors almanac: Charting your journey, Hoboken, NJ: John Wiley & Sons, Inc. Lee, N, Chang, Y, Adimorah, N, Belkora, K, Moy, B, Partridge, H, Ollila, W, & Sepucha, K 2012, ‘Decision making about surgery for early-stage breast cancer’, Journal of the American College of Surgeons, 214(1), pp. 1–10. Peppercorn, M, Smith, J, Helft, R, Debono, J, Berry, R, Wollins, S, Hayes, M, Von Roenn, H, & Schnipper, E 2011, ‘American Society of Clinical Oncology statement: Toward individualized care for patients with advanced cancer’, Journal of Clinical Oncology, 29(6), pp. 755–760. Sepucha, R, Fowler, J, & Mulley, G 2004, ‘Policy support for patient-centered care: The need for measurable improvements in decision quality’, Health Affairs. Villas Boas, J, Spagnuolo, S, Kamegasawa, A, Braz, G, Polachini do Valle, A, Jorge, C, Yoo, H, Cataneo, J, Correa, I, Fukushima, B, Nascimento, P, Modolo, S, Teixeira, S, de Oliveira Vidal, I, Daher, R, & El Dib, R 2012, ‘Systematic reviews showed insufficient evidence for clinical practice in 2004: What about in 2011? The next appeal for the evidence-based medicine age’, Journal of Evaluating Clinical Practice, 19(4), pp. 633–637. Weeks, C, Catalano, J, Cronin, A, Finkelman, D, Mack, W, Keating, L, & Schrag, D 2012, ‘Patients expectations about effects of chemotherapy for advanced cancer’, New England Journal of Medicine, 17, pp. 1616–1625. Read More