Patient participation in clinical encounters: A systematic review to identify self-report measures

Abstract

Background: There is evidence suggesting that active participation of patients in their health care can improve the quality of care and decrease health-care costs. Further, patient reports of their health-care experience are increasingly used to monitor health-care quality. Objective: This paper describes a systematic review of peer-reviewed studies to identify measures of patients' active participation in their encounters with health-care providers. Methods: A systematic literature review was conducted for publications indexed from 1975 to 2011. Of interest were self-reported measures of patient participation that were not limited to a specific health concern. All abstracts were reviewed independently by two authors, and the full paper was considered for those meeting inclusion criteria. Main Results: From a review of 4528 citations, ten measures were identified. The approaches to development of the measures varied considerably, as did their study samples and their psychometric quality. Discussion: These measures represented three conceptual frameworks: empowerment and self-efficacy, therapeutic alliance, and consumerism/satisfaction. They provide a more comprehensive perspective of patients' experiences of their provider encounters, and a better understanding patient behaviour enhanced the quality of health-care delivery or improved health outcomes. These measures underscore the continuing challenge of defining patient participation and the multiple theoretical approaches that underlie this form of patient behaviour. Conclusions: Current interest in quality-related physician report cards gives significant weight to patients' self-reported experiences as one dimension of physician performance. It is critical to identify the specific focus and quality of measures selected for this and research purposes.