Study Suggests New Concept Regarding Patient Autonomy When Coping with Multiple Chronic Conditions
The concept of patient autonomy was developed in the context of acute care and has centered on decisional autonomy - the patient's capacity to understand information and to make voluntary decisions, particularly in regard to authorizing treatment interventions. The clinical benchmark for evaluating patient autonomy in this setting is their capacity to participate in the informed consent process. However, this one-component concept of patient autonomy may be problematic in the context of multiple chronic conditions that require the patient to participate in their treatment plan beyond providing consent. Adherence to complex treatments that require patient self-management may break down when patients have functional, educational, and cognitive barriers that impair their capacity to plan and carry out tasks associated with chronic care.
Authors in this article call for a new two-component concept that includes both autonomous decision-making and the execution of the agreed upon treatment plan. Effective treatment planning may be achieved by identifying the patient's limitations, tailoring appropriate interventions, and providing adequate support. Authors suggest that the two-component concept of patient autonomy could have profound effects on the patient-clinician relationship and overall health outcomes.
Naik A, Dyer C, Kunik M, and McCullough L. Patient autonomy for the management of chronic conditions: A two-component re-conceptualization. The American Journal of Bioethics February 2009;9(2):23-30.
This study was partly supported through HSR&D's Houston Center for Quality of Care and Utilization Studies (HCQCUS). Drs. Naik and Kunik are part of HCQCUS and the Michael DeBakey VA Medical Center in Houston.