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Factors constraining patient engagement in implantable medical device discussions and decisions: interviews with physicians.


ABSTRACT:

Objective

Patient engagement (PE) is warranted when treatment risks and outcomes are uncertain, as is the case for higher risk medical devices. Previous research found that patients were not engaged in discussions or decisions about implantable medical devices. This study explored physician views about engaging patients in such discussions.

Design

Qualitative interviews using a basic descriptive approach.

Setting

Canada.

Participants

Practicing cardiovascular and orthopaedic physicians.

Main outcome measures

Level, processes and determinants of PE in medical device discussions and decisions.

Results

Views were largely similar among 10 cardiovascular and 12 orthopaedic physicians interviewed. Most said that it was feasible to inform and sometimes involve patients in discussions, but not to partner with them in medical device decision-making. PE was constrained by patient (comfort with PE, technical understanding, physiologic/demographic characteristics, prognosis), physician (device preferences, time), health system (purchasing contracts) and device factors (number of devices on market, comparative advantage). A framework was generated to help physicians engage patients in discussions about medical devices, even when decisions may not be preference sensitive due to multiple constraints on choice.

Conclusions

This study identified that patients are not engaged in discussions or decisions about implantable medical devices. This may be due to multiple constraints. Further research should establish the legitimacy, prevalence and impact of constraining factors, and examine whether and how different levels and forms of PE are needed and feasible.

SUBMITTER: Gagliardi AR 

PROVIDER: S-EPMC5412024 | biostudies-literature | 2017 Apr

REPOSITORIES: biostudies-literature

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Publications

Factors constraining patient engagement in implantable medical device discussions and decisions: interviews with physicians.

Gagliardi Anna R AR   Lehoux Pascale P   Ducey Ariel A   Easty Anthony A   Ross Sue S   Bell Chaim M CM   Trbovich Patricia P   Takata Julie J   Urbach David R DR  

International journal for quality in health care : journal of the International Society for Quality in Health Care 20170401 2


<h4>Objective</h4>Patient engagement (PE) is warranted when treatment risks and outcomes are uncertain, as is the case for higher risk medical devices. Previous research found that patients were not engaged in discussions or decisions about implantable medical devices. This study explored physician views about engaging patients in such discussions.<h4>Design</h4>Qualitative interviews using a basic descriptive approach.<h4>Setting</h4>Canada.<h4>Participants</h4>Practicing cardiovascular and ort  ...[more]

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