Improving health care by understanding patient preferences: the role of computer technology

Learning points from paper

• If nurses, physicians, and health care planners knew more about patients' health-related preferences, care would most likely be cheaper, more effective, and closer to the individuals' desires.
• Patient preferences result from cognition, experience, and reflection and exist as the relatively enduring consequences of values (see Improving the quality of patient care: the role of patient preferences in the clinical record).
• There are alternative meanings of the term “Preferences”, e.g. the patient's final choice of treatment, vs the patient's choice of features for a given treatment.
• Acting on the patient's preferences is hard, even though the value of knowing the preferences is well understood (see Through the patient's eyes), patients are not trained to think about abstract clinical concepts, and being ill is stressful.
  
• Computer technology can help in gathering patient preferences, e.g. tools that focus on elicitation and values clarification may help patients think hard about complex, abstract issues, such as the desirability of future states (see Patient reactions to a program designed to facilitate patient participation in treatment decisions for benign prostatic hyperplasia) and they can be delivered outside of the stressful hospital environment with enough time for the patient to consider options (see Automated computer interviews to elicit utilities: potential applications in the treatment of deep venous thrombosis).

Critique of paper

Other comments

Nice list of project using computer techology to research patient preferences.

• Eliciting preferences: The Stanford Center for the Study of Patient Preference has pioneered the use of computers and the Internet for low-cost elicitation of patient preferences for health states. Their Comprehensive Health Enhancement Support System (CHESS) is a health promotion and support network application that operates as a module-based computer system for in-home or health care setting use. See The use and impact of a computer-based support system for people living with AIDS and HIV infection.
• Monitoring preferences over time: At Dana-Farber Cancer Institute, reports of health-related quality of life are obtained from cancer patients each time they go to the breast cancer outpatient clinic (see What constitutes quality of life? Concepts and dimensions).
• Envisioning treatment alternatives: The technology-based Shared Decision-making Program (SDP) was developed within a framework grounded in the idea that rational treatment decision-making considers both what the patient wants and what the clinician views as appropriate. The program was designed for use in the clinic setting to aid patients facing complex treatment choices (see Developing shared decision-making programs to improve the quality of health care).
• Linking preferences with treatment recommendations: The Department of Family Practice at the Medical College of Virginia, Virginia Commonwealth University, designed HealthTouch, a computerized health information system for health promotion and disease prevention for use in primary care (see Patient use of a computer for prevention in primary care practice).

Citation and Abstract

1: J Am Med Inform Assoc. 1998 May-Jun;5(3):257-62.

Improving health care by understanding patient preferences: the role of computer technology.

Brennan PF, Strombom I.

University of Wisconsin, Madison 53706, USA. pbrennan@engr.wisc.edu

If nurses, physicians, and health care planners knew more about patients' health-related preferences, care would most likely be cheaper, more effective, and closer to the individuals' desires. In order for patient preferences to be effectively used in the delivery of health care, it is important that patients be able to formulate and express preferences, that these judgments be made known to  the clinician at the time of care, and that these statements meaningfully inform  care activities. Decision theory and health informatics offer promising strategies for eliciting subjective values and making them accessible in a clinical encounter in a manner that drives health choices. Computer-based elicitation and reporting tools are proving acceptable to patients and clinicians alike. It is time for the informatics community to turn their attention toward building computer-based applications that support clinicians in the complex cognitive process of integrating patient preferences with scientific knowledge, clinical practice guidelines, and the realities of contemporary health care.

PMCID: PMC61299
PMID: 9609495 [PubMed - indexed for MEDLINE]

Related Links

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PMID:11861634

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