What is the relationship between communication, the physician/patient relationship, shared decision making and health literacy?
Effective communication in a clinical context contributes to health literacy. Healthcare decisions are the result of health literacy, which is the process of choosing between courses of action from interpretation to evaluating health information in the social and physical environment. One of the most important aspects of communication is to reduce uncertainty and achieve valued outcomes. In the clinical context, communication serves as a bridge to help both patients and physicians to understand each other. The ultimate purpose is to find the solution to apply health knowledge and thus reduce the uncertainty about daily health decision-making process. Kasper’s article ‘Shared Decision Making (SDM)’ Meets Communication Theory demonstrates that uncertainty is the subject of both parties’ engagement in communication. This indicates that communication is the foundation of forming a partnership relationship in the long term. Effective communication between physicians and patients is based on the doctor’s clinical expertise, patient preferences and external evidence on scientific knowledge. Bringing them all together contribute to improve people’s health literacy skills.
According to Kasper’s article, “SDM is a two-way exchange of information between the parties concerned with the medical decision either from the professional or from a patient’s point of view.” This is to say that decision-making is based on the conversation between two parties. It
is about respecting autonomy and coordination. As Kasper points out, “The process of transferring information is seen from a systems theory viewpoint as a co-operative invention, where information results from interaction. Beyond this co-operation on the level of content, this process is shaped by the dyad’s interpersonal relations.” Thus, SDM is interactive between physicians and patients, and builds upon mutual respect alongside the collaborative relationship.
Shared decision-making helps to build a partnership relationship between physicians and patients because physicians take patients’ emotional needs into account. This relationship is based on patient-centered care which is built upon patients’ perspectives. The Pinnacle of Patient-Centered Care article addresses the dimensions of care that the patients are putting on higher values. For example, respect for the patient’s values, preferences, and expressed needs are the foundation of establishing coordinated and integrated care. Physicians of clear, high-quality information would help reduce the gap between doctors and patients. Additionally, it is crucial to strength the relationship by giving patients emotional support and thus alleviating their fears and anxieties. According to the authors, “successfully addressing these dimensions requires enlisting patients and families as allies in designing, implementing, and evaluating care systems.” This means appropriately involving family members and friends as a support system and utilizing the information from doctors would strength the relationship between physicians and patients.
Shared decision-making contributes to better health outcomes. According to Stigglebout’s article SDM: Really Putting Patients at the Centre of Healthcare, SDM can not only help patients make reasoned informed choices but also help them to balance the benefits and risk of the treatments. This is to say, physicians need to discuss the evidence transparently and ask for their patients’ preferences regarding to the benefits and harms of the treatments. Patients can therefore gain better understanding of their health status and in turn help themselves to make decisions. However, there are no right or wrong choices, as Stigglebout states: “For shared decision-making to occur, a form of partnership should be built that goes beyond rapport and involves sharing responsibility.” The implication of the partnership on the physician side is to facilitate the conversation by providing their patients with pros and cons regarding the healthcare decision in question. Ideally, patients would be more willing to participate in decision-making about healthcare options. Ultimately, the partnership between physicians and patients not only help patients to better understand their own health status and related health knowledge, but also help physicians to understand how to provide the best available evidence and thus decide which information and services work best for different situations and people.
However, miscommunication between physicians and patients can lead to lower health literacy. According to Williams’ article The Role of Health Literacy in Patient-Physician Communication, “Patients with poor health literacy have a complex array of communications difficulties that may affect health outcomes. Such patients report worse health status and have less understanding about their medical conditions and treatments; they may have increased hospitalization rates.” It is necessary for both of the parties to acquire the shared decision-making skills which will improve the overall health outcomes. For example, by using decision aids like multimedia, doctors can help provide information on options and clarify the personal values. With the help of health decision aids, individuals can make plans based on identified needs and thus achieve better health outcomes.
“Result Filters.” National Center for Biotechnology Information. U.S. National Library of Medicine, n.d. Web. 7 Feb. 2015. <http://www.ncbi.nlm.nih.gov/pubmed/21323823>.