A unified framework for joint patient-physician collaboration: The colorectal cancer screening problem

Abstract

As patients have become more active in their medical decisions, healthcare providers have increasingly emphasized patient-centred care. To deliver such care, providers must respect patients’ needs and preferences and ensure that patients’ values are a centrepiece of clinical decisions. This research proposes a framework for shared decision-making, capable of analytically incorporating patients’ preferences and physicians’ expertise into a joint patient-physician (JPP) model to overcome the barriers encountered in clinical patient-centred care. The JPP framework combines patient’s wishes and physician’s judgments coherently and transparently and generates user-friendly guidance for discussion in a subsequent medical encounter. We examine the impact of integrating patient’s preferences with physician’s expertise for preventive healthcare in the case of choosing an appropriate colorectal cancer screening option. Our results indicate that two possible scenarios might be encountered: (a) the patient-preference-only model and the JPP model do not result in the same screening alternative, and (b) the two models agree in their recommendation. We identify the structural differences in the two models associated with both scenarios. The results show that clinically the proposed JPP model has the capability of providing a transparent starting point for discussions between the patient and the physician.

Keywords:

• Shared decision-making
• joint patient-physician model
• patient-centred care
• preventive healthcare services
• Analytic Network Process (ANP)

Acknowledgements

The authors thank the associate editor and the referees for their helpful and constructive comments during the first round of review.

Disclosure statement

No potential conflict of interest was reported by the authors.

Figure A1. Pairwise comparisons for patients’ preferences elicitation.

Notes

1 The questionnaire was developed in the style of Dolan and Frisina (2002) and Dolan et al. (2013).

2 A new look at colon cancer screening, Harvard Men’s Health Watch, October 2016, https://www.health.harvard.edu/staying-healthy/a-new-look-at-colon-cancer-screening