Getting from “Delivering Care to Patients” to “Partnership with Patients”

  • Alexander Blount


The IOM’s call for patients to be the source of control in their care has been represented differently at different times. The patient as the source of control has evolved from the clinician’s taking the patient’s preferences and values into account in designing care to a partnership between the clinician and the patient in making the choices necessary to plan care. This is a particularly challenging standard because both health professionals and many of their patients have been socialized to the model of the doctor leading care. Their difference in knowledge and in their perspective on the patient’s illness makes partnership difficult. This makes partnership challenging, even if the difference in levels of knowledge about the patient’s illness is reduced. Motivational interviewing, shared decision-making, minimally disruptive medicine, addressing health literacy, relationship-centered care, and coaching patients to be more assertive in relating to their physician, each of these approaches can be an important contribution, and each one demands extra attention and time to be effectively implemented. For some patients with particularly complex health situations, additional expertise on the part of the healthcare team is necessary to impact their health outcomes.


Patient participation Healthcare reform Primary care Shared decision-making Minimally disruptive 


  1. 1.
    Frampton S, Guastello S, Hoy L, Naylor M, Sheridan S, Johnston-Fleece M. Harnessing evidence and experience to change culture: a guiding framework for patient and family engaged care. National Institute of Medicine. 2017.
  2. 2.
    Kuzel AJ, Woolf SH, Gilchrist VJ, Engel JD, LaVeist TA, Vincent C, Frankel RM. Patient reports of preventable problems and harms in primary health care. Ann Fam Med. 2004;2(4):333–40.CrossRefGoogle Scholar
  3. 3.
    Elder NC, Imhoff R, Chubinski J, et al. Congruence of patient self-rating of health with family physician ratings. JABFM. 2017;30:196–204.CrossRefGoogle Scholar
  4. 4.
    Kruse RL, Olsberg JE, Shigaki CL, Oliver D, Vetter-Smith M, Day T, LeMaster J. Communication during patient-provider encounters regarding diabetes self-management. Fam Med. 2013;45:475–83.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Parker RM. Health literacy: a challenge for American patients and their healthcare providers. Health Promot Int. 2000;15:277–91.CrossRefGoogle Scholar
  6. 6.
    Hayes MV, Ross IE, Gashner M, Gutstgein D. Telling stories: news media, health literacy and public policy in Canada. Soc Sci Med. 2007;64:1842–52.CrossRefGoogle Scholar
  7. 7.
    Institute of Medicine. Health literacy: a prescription to end confusion. Washington, DC: National Academies Press; 2004.Google Scholar
  8. 8.
    Nutbeam D. The evolving concept of health literacy. Soc Sci Med. 2008;67:2072–6.CrossRefGoogle Scholar
  9. 9.
    Paasche-Orlow MK, Wolf MS. The causal pathway lining healthy literacy to health outcomes. Am J Health Behav. 2007;31:S19–26.CrossRefGoogle Scholar
  10. 10.
    Miller WR, Rollnick S. Motivational Interviewing, Helping People Change. 3rd ed. New York: Guilford Press; 2012.Google Scholar
  11. 11.
    Prochaska JO, DiClemente CC. The Transtheoretical approach: towards a systematic eclectic framework. Homewood: Dow Jones Irwin; 1984.Google Scholar
  12. 12.
    Miller WR, Rollnick S. Motivational Interviewing: Preparing People to Change Addictive Behavior. New York: Guilford Press; 1991.Google Scholar
  13. 13.
    Rauch J. How not to die. The Atlantic. May, 2013: 65–69.Google Scholar
  14. 14.
    Bodenheimer T, Lorig K, Holman H, Grumbach K. Patient self-management of chronic disease in primary care. JAMA. 2002;288:2469–75.CrossRefGoogle Scholar
  15. 15.
    Guadagnoli E, Ward P. Patient participation in decision-making. Soc Sci Med. 1998;47:329–39.CrossRefGoogle Scholar
  16. 16.
    Devine EC, Cook TD. A meta-analytic analysis of effects of psychoeducational interventions on length of postsurgical hospital stay. Nurs Res. 1983;32:267-274.CrossRefGoogle Scholar
  17. 17.
    Stiggelbout AM, Van der Weijden T, De Wit MPT, et al. Shared decision making: really putting patients at the centre of healthcare. BMJ. 2012;344:1–6.CrossRefGoogle Scholar
  18. 18.
    Onel E, Hamond C, Wasson JH, et al. Assessment of the feasibility and impact of shared decision making in prostate cancer. Urology. 1998;51:63–6.CrossRefGoogle Scholar
  19. 19.
    Elwyn G, Dehlendorf C, Epstein RM, Marrin K, White J, Frosch DL. Shared decision making and motivational interviewing: achieving patient-centered care across the spectrum of health care problems. Ann Fam Med. 2014;12:270–5.CrossRefGoogle Scholar
  20. 20.
    O’Connor AM, Legare F, Stacey D. Risk communication in practice: the contribution of decision aids. BMJ. 2003;327:736–40. Scholar
  21. 21.
    Cvengros JA, Christensen AJ, Hillis SL, Rosenthal GE. Patient and physician attitudes in the health care context: attitudinal symmetry predicts patient satisfaction and adherence. Ann Behav Med. 2007;33:262–5.CrossRefGoogle Scholar
  22. 22.
    Barry MJ, Edgman-Levitan S. Shared decision making – the pinnacle of patient-centered care. N Engl J Med. 2012;366:780–1.CrossRefGoogle Scholar
  23. 23.
    Lagare F, Stacey D, Turcotte S, et al. Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database Syst Rev. 2014.
  24. 24.
    Couët N, Desroches S, Robitaille H, Vaillancourt H, Leblanc A, Turcotte S, et al. Assessments of the extent to which health-care providers involve patients in decision making: a systematic review of studies using the OPTION instrument. Health Expectations. 2015;18:542–61.CrossRefGoogle Scholar
  25. 25.
    Leppin AL, Montori VM, Gionfriddo MR. Minimally disruptive medicine: a pragmatically comprehensive model for delivering care to patients with multiple chronic conditions. Healthcare. 2015;3:50–63.CrossRefGoogle Scholar
  26. 26.
    Jowsey T, Yen L, Mathews WP. Time spent on health-related activities associated with chronic illness: a scoping literature review. BMC Public Health. 2012;12:1044.CrossRefGoogle Scholar
  27. 27.
    Shippee ND, Shah ND, May CR, Mair FS, Montori VM. Cumulative complexity: a functional, patient-centered model for patient complexity can improve research and practice. J Clin Epidemiol. 2012;65:1041–51.CrossRefGoogle Scholar
  28. 28.
    Leppin AL, Gionfriddo MR, Kessler M, et al. Preventing 30-day hospital readmissions: a systematic review and meta-analysis of randomized trials. JAMA Intern Med. 2014;174:1095–107.CrossRefGoogle Scholar
  29. 29.
    Kiecolt-Glaser JK, Fisher LD, Grocki P, Stout J, Speicher C, Glaser R. Marital quality, marital disruption, and immune function. Psychosom Med. 1987;49:13–34.CrossRefGoogle Scholar
  30. 30.
    Uchino BN, Cacioppo JT, Kiecolt-Glaser JK. The relationship between social support and physiological processes: a review with emphasis on underlying mechanisms and implications for health. Psychol Bull. 1996;119:488–531.CrossRefGoogle Scholar
  31. 31.
    Rakel DP, Hoeft TJ, Barrett BP, et al. Practitioner empathy and the duration of the common cold. Fam Med. 2009;41:494–501.Google Scholar
  32. 32.
    Rossland A, Heisler M, Piette JD. The impact of family behaviors and communication patterns on chronic illness outcomes: a systematic review. J Behav Med. 2012;35:221–39.CrossRefGoogle Scholar
  33. 33.
    Kaplan SH, Greenfield S, Ware JE. Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care. 1989;27:S110–27.CrossRefGoogle Scholar
  34. 34.
    Haug MR, Lavin B. Public challenge of physician authority. Med Care. 1979;17:429.CrossRefGoogle Scholar
  35. 35.
    Vertinsky JB, Thompson WA, Uyeno D. Measuring consumer desire for participation in clinical decision-making. Health Serv Res. 1974;15:121.Google Scholar
  36. 36.
    Woolley FR, Kane RI, Hughes CC, et al. The effects of doctor-patient communication on satisfaction and outcome of care. Soc Sci Med. 1978;12:123.PubMedGoogle Scholar
  37. 37.
    Patrick DL, Scrivens E, Charlton J. Disability and patient satisfaction with medical care. Med Care. 1983;21:1062.CrossRefGoogle Scholar
  38. 38.
    Belkora J, Edlow B, Aviv C, Sepucha K, Esserman L. Training community resource center and clinic personnel to prompt patients in listing questions for doctors: follow-up interviews about barriers and facilitators to the implementation of consultation planning. Implement Sci. 2008;3:6.CrossRefGoogle Scholar
  39. 39.
    Adelman AM, Graybill M. Integrating a health coach into primary care: reflections from the Penn State ambulatory research network. Ann Fam Med. 2005;3:S33–5.CrossRefGoogle Scholar
  40. 40.
    Tresolini CP. Pew-Fetzer task force on advancing psychosocial health education. Health Professions Education and Relationship-Centered Care. 1994. Pew Health Professions Commission, San Francisco.
  41. 41.
    Beach MC, Inui T, The Relationship-Centered Research Network. Relationship-centered care: a constructive reframing. J Gen Intern Med. 2006;21:S3–8.CrossRefGoogle Scholar
  42. 42.
    Soklareidis S, Ravitz P, Nevo GA, Lieff S. Relationship-centered care in health: a 20-year scoping review. Patient Exp J. 2016;3:130–45.Google Scholar
  43. 43.
    Suchman AL, Sluyter DJ, Williamson PR, editors. Leading change in healthcare. London: Radcliffe Publishing; 2011.Google Scholar
  44. 44.
    Watzlawick P, Bavelas JB, Jackson DD. Pragmatics of human communication. New York: W. W. Norton; 1967.Google Scholar
  45. 45.
    Miller WR. Living as if. Philadelphia: Westminster Press; 1985.Google Scholar
  46. 46.
    Carney DR, Cuddy AJC, Yap AJ. Brief nonverbal displays affect neuroendocrine levels and risk tolerance. Psychol Sci. 2010;21:1363–8.CrossRefGoogle Scholar
  47. 47.
    Ryan P, Sawin KJ. The individual and family self-management theory: background and perspectives on context, process, and outcomes. Nurs Outlook. 2009;57:217–25.CrossRefGoogle Scholar
  48. 48.
    Weihs K, Fisher L, Baird M. Families, health, and behavior. Fam Syst Health. 2002;20:7–46.CrossRefGoogle Scholar
  49. 49.
    Lewis N, Gray SW, Freres DR, Hornik RC. Examining cross-source engagement with cancer-related information and its impact on doctor-patient relations. Health Commun. 2009;24:723–34.CrossRefGoogle Scholar
  50. 50.
    Kleinman A, Eisenberg L, Good B. Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Ann Intern Med. 1978;88:251–8.CrossRefGoogle Scholar
  51. 51.
    Siminoff LA. Incorporating patient and family preferences into evidence-based medicine. BMC Med Inform Decis Mak. 2013;13:S6.CrossRefGoogle Scholar
  52. 52.
    Arpin K, Fitch M, Browne GB, Corey P. Prevalence and correlates of family dysfunction to chronic illness in specialty clinics. J Clin Epidemiol. 1990;3:373–83.CrossRefGoogle Scholar
  53. 53.
    Medalie JH, Goldbourt U. Angina pectoris among 10,000: psychosocial and other risk factors as evidenced by a multivariate analysis of a five-year incidence study. Am J Med. 1976;60:910–21.CrossRefGoogle Scholar
  54. 54.
    Morisky DE, DeMuth NM, Field-Fass M, Green LW, Levine DM. Evaluation of family health education to build social support for long-term control of high blood pressure. Health Educ Q. 1985;12:35–50.CrossRefGoogle Scholar
  55. 55.
    Mittleman MS, Ferris SH, Mackell JA, Ambinder A, Cohen J. An intervention that delays institutionalization of Alzheimer’s disease patients: treatment of spouse caregiver. The Gerontologist. 1993;35:792–802.CrossRefGoogle Scholar
  56. 56.
    Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academies Press; 2001.Google Scholar
  57. 57.
    Healthy People 2020.


    Patients Advocating for Patient Participation

    Health Literacy Resources

    1. From the Office of Disease Prevention and Health Promotion:
    2. Chronic pain tools for patients with low reading levels.
    3. Agency for Healthcare Research and Quality health literacy toolkit for health systems.
    4. Videos on Culture and Health Literacy:
    5. Agency for Healthcare Quality and Research offers a guide for improving patient-provider communication

    Shared Decision-Making Resources

      For Professionals

      1. Ottawa Hospital Patient Decision Aides and the Healthwise Knowledgebase. The Healthwise Knowledgebase is intended for professional evaluation and not intended for distribution directly to patients or consumers.

      Decisional Aids for Patients

      1. Mayo Clinic Shared Decision-Making National Resource Center. 1/27/18 offers tool kits for 8 conditions.
      2. Best access to multiple medical decision aids websites:

    Minimally Disruptive Medicine

    1. Blog and connecting point for those interested—

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Alexander Blount
    • 1
  1. 1.Department of Clinical PsychologyAntioch University New EnglandKeeneUSA

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