Patient Perceptions of Participation in Treatment Several

¶ … Patient Perceptions of Participation in Treatment

Several studies have revealed that patients generally prefer to learn everything they can about their illness and the proposed treatment plan, and even have some control during the planning stage (reviewed in Lund, Tamm, and Branholm, 2001). On the other hand, studies have found that occupational therapists typically underestimate this desire and tend to perceive patients as passive and uncooperative. The gap between the patient's wishes to actively participate and the therapists' perceptions of that willingness can result in a number of problems, including patient compliance with treatment plans and goals. Strategies to minimize the size of this gap could therefore lead to more effective rehabilitation of the patient's disability.

A study was conducted in Sweden that examined patients' experiences as a rehabilitation patient and the professional's view of the interaction (Lund, Tamm, and Branholm, 2001). Patients were enrolled from acute care in surgery, othropaedics, and medicine, and rehabilitative care for geriatrics and general rehabilitation, from local two hospitals. Patients with cognitive deficits or undergoing palliative care were excluded from the study. Of the 57 patients surveyed, 40% were content to let the therapist or nurse plan and implement treatment (relinquishers), 25% occasionally participated, and 35% preferred to be fully engaged (participators). There appeared to be a cultural gender bias among the respondents, with more men wanting to fully participate and more women willing to fully surrender to professional expertise.

Of the patients who willingly relinquished the decision-making role to the therapist, 30% wished they had received more information about their condition and treatment plan (Lund, Tamm, and Branholm, 2001). In spite of this complaint, most of these patients were satisfied with their rehabilitation experience. The more troubling finding was that the 'occasionally participated' group almost uniformly felt ignored by their treating nurses, physicians, or therapists and excluded from the planning of their rehabilitation treatment. Some patients from this group also expressed feeling unwelcome at the hospital, that they were discharged too soon, and were unable to cope with managing daily living activities after returning home. If the number of 'relinquisher' patients who felt they were under-informed is added to the number in the 'occasionally participated' group, then 38% of all patients surveyed had a less than optimum rehabilitative experience from their perspective.

Interestingly, all patients within the 'occasionally participated' group had to interact with a team of professionals consisting of physicians, nurses, social workers, physiotherapists, and occupational therapists, which may explain the felt indifference (Lund, Tamm, and Branholm, 2001). Professional teams treated most of the 'relinquisher' patients, but only half of the participating patients. Of the participating patients that were team-treated, most expressed experiencing hesitation to express their needs in front of the group of professionals.

When the perspectives of the professional caregivers was surveyed, nurses tended to favor a role as information provider, whereas occupational therapists tended to go further by engaging patients in the decision-making process (Lund, Tamm, and Branholm, 2001). This skewing of the professional perception persisted in the relinquisher and full participant groups, but almost disappeared in nurses treating occasional participants. Overall, this finding highlight the large gap between what a patient and professional perceives about the decision-making process and suggests professional perceptions are influenced primarily by their training and work environment. The one exception to this bias was the nurses interacting with patients who occasionally participated, which suggests patient and nurse perceptions were more closely aligned in this group.

Lund, Tamm, and Branholm (2001) concluded from their study that professionals largely continue to remain indifferent to the needs and wishes of patients during the decision-making process for occupational therapy treatment. Even though occupational therapists preferred to engage patients in decision-making, at least 40% of patients preferred that the therapist not include them in this aspect of their treatment. The results here suggest that improvement in patient satisfaction could depend in part on eliminating team-patient interactions. Doing so may allow otherwise reticent patients to express their needs more openly.