How are patients’ values and beliefs taken into account when practicing evidence-based healthcare?

Posted on 5th January 2024 by Vaishnavi Pawar

Introduction

As diseases become more tortuous and treatment options increase, it’s important to consider the latest clinical evidence when making health decisions in order to provide safe, high-quality, and cost-effective patient care. Determining the best approach to deal with clinical situations is not always easy.

Evidence-based medicine (EBM) is a way of using science to answer questions about patient care in various situations. It helps healthcare providers make decisions based on evidence. Evidence-based practice (EBP) refers to the careful and thoughtful use of the most current and reliable evidence in combination with clinical expertise and patient values to guide healthcare decision-making. This evidence may come from various sources, including empirical evidence from randomized controlled trials, and other scientific methods such as descriptive and qualitative research. In addition, information from case reports, scientific principles, and expert opinions may also be utilized. After the collection of sufficient research evidence, healthcare professionals can rely on it, along with their clinical expertise and patient values, to make informed decisions. Evidence-based healthcare (EBHC) means combining clinical knowledge with the best available research evidence. When evidence is presented in a clear and accessible way, it can help healthcare professionals make better decisions. This can lead to improved patient outcomes.

EBM vs EBHC

It is important to differentiate between two terms in healthcare: EBM and EBHC. EBM is a decision-making approach used by physicians when treating individual patients. On the other hand, EBHC is a broader concept that incorporates a more advanced understanding of patients, families, and doctors’ beliefs, values, and attitudes. EBHC also relies on evidence but primarily considers population-level data. Patient values refer to patients’ preferences, beliefs, goals, and expectations about their health and well-being. These values may vary depending on their cultural, religious, and personal background.

Let’s consider an example of a patient diagnosed with a certain type of cancer. Studies may indicate that chemotherapy increases life expectancy from 8 to 16 months; however, this treatment is known to have significant adverse effects. As such, the patient may choose not to pursue chemotherapy due to their values and preferences. To provide patient-centered care, this understanding is vital for various reasons. The patient’s thoughts about health, such as the cause of disease, the extent of control over the cure rate, and the value of different treatments, can predict their health behaviours, including medication adherence, healthcare service usage, and lifestyle choices.

The role of the patient in EBHC

By better understanding a patient’s health beliefs, healthcare providers can identify any difference between their knowledge and the patient’s perception of their health situation. This can lead to more appropriate treatment choices based on the patient’s needs and expectations.

To engage patients in their care decisions, healthcare providers should ask open-ended questions, actively listen, show empathy, validate and support their emotions, and create a safe and trusting environment. By doing so, health care professionals can better understand their patients and provide care that meets their individual needs. This requires accurate, relevant, and understandable information about their diagnosis, prognosis, treatment options, benefits, risks, and expected outcomes. It’s also essential to explain the evidence and rationale behind the recommended course of action and clarify any doubts or misconceptions the patient may have. The information should be presented in plain language, using visual aids and teach-back methods to ensure complete comprehension.

Before proceeding, verifying the patient’s consent and agreement is essential.  Involving patients in care decisions is crucial and requires collaboration and negotiation. This means treating them as equal partners in decision-making and respecting their right to accept or decline any intervention or service offered. It also involves understanding the patient’s values, goals, and preferences and how they align or conflict with the available options.

Collaborating and negotiating with the patient means finding a balance between their wishes and the best available evidence, offering guidance and support without coercion or judgment, supporting the patient’s rights, interests, and needs, and defending them from any barriers, biases, or discrimination that may affect their care. It also means empowering the patient to take an active role in their health and well-being and to access the necessary resources and services.

Patients need to feel confident and resilient in order to take control of their health. This means empowering them to believe in their own health, understand what causes their illness, and know how to overcome it. These beliefs are shaped by culture and form a larger health belief system. By advocating for and supporting patients in this way, we can enhance their quality of life. Patients’ beliefs regarding their illness and its treatment are considered crucial for their adherence to the prescribed treatment.

Importance of Health Belief Model

The Health Belief Model (HBM) originally defined beliefs as predictors of preventive healthcare behaviour. This includes how people perceive the “threat posed by the illness.” The threat has two parts: how likely the illness is to happen (perceived susceptibility) and how much harm it can cause physically and socially (perceived severity). Researchers have studied how much people perceive the severity of the disease threat, along with other parts of the HBM, to predict how well patients will follow their treatment. It’s assessed that if people have the perception the disease is more severe, they will follow their treatment better.

Conclusion

Evidence-based medicine (EBM) and evidence-based healthcare (EBHC) play a vital role in modern healthcare by enabling better decision-making while considering the patients’ perceptions. When patients are involved in decision-making, the outcomes of their treatment are enhanced. Healthcare providers should encourage patients to be more resilient in decision-making, considering that patients may have limited knowledge regarding their treatment options.

References (pdf)

You may also be interested in reading the following blogs:

Making health decisions: my health deserves more

What is evidence-based medicine?

Shared decision making: a vital aspect of everyday care in all healthcare settings

Evidence-based health practice: a fairytale or reality?

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