Page 208 - Psychology of Wounds and Wound Care in Clinical Practice ( PDFDrive )

Patient Satisfaction and Patient Centred Care 183

• the involvement of the patient in decisions about
treatment.
The patient will therefore be more satisfied and less anxious
if they feel that they have been understood and their requests
have been met (Like and Zyzanski 1986 , 1987 ). This in turn will
lead to better concordance (Kerse et al. 2004 ). To ensure that
the patient has had all their questions answered satisfactorily,
and any misunderstandings clarified, the clinician will have to
bear in mind that the patient might be viewing their illness and
its treatment through a different lens to the clinician due to
their individual heath beliefs and illness perceptions.
To ensure a patient centred consultation, clinicians will
also need to evaluate the extent to which the patient wishes
to be involved in decision-making (McKinstry 2000 ). Whilst
there is some evidence that the majority of patients do want
healthcare practitioners to take a patient centred approach
(Little et al. 2001 ), there is also evidence that the aspect of
patient centred care that is universally valued concerns com-
munication. In contrast the desire for involvement in treat-
ment decisions depends on a number of different factors
including the patient’s age, sex and social background, and
the type and duration of illness (McKinstry 2000 ). Thus there
is a tendency for males, older patients, those from a lower
socio-economic background and with a lower level of educa-
tion to prefer clinicians to take a more directive approach,
although these associations are not absolute, with large
minorities in each group (McKinstry 2000 ). However,
evidence does support the desirability of shared decision-
making in chronic illness (McKinstry 2000 ; Joosten et al.
2008 ). Not only does shared decision making appear to be
more desired in long term conditions, it also appears that it
may be more effective for concordance (Joosten et al. 2008 ).
It has therefore been suggested that clinicians need to take a
flexible approach to patient-centred consultation in order to
enhance patient satisfaction and concordance (Swenson et al.
2004 ). Clinicians therefore need the skills, to determine when
and to what extent their patients wish to be involved in
decision making in order to be truly patient centred.