patients’ capability for self-management given adequate support and education stems from models developed for chronic conditions such as heart disease, stroke, lung disease, arthritis, and diabetes (see the earlier discussion of the Chronic Care Model). In these studies, providers educated patients about managing the symptoms and problems associated with their conditions and taught good medication self-management practices and healthful behaviors. For example, patients with vascular disease demonstrated high self-efficacy in medication use, exercise, and weight control when interventions emphasized the importance of self-management, supplied information on visible physiological changes and performance accomplishments, and used nursing staff for patient support and communications (Sol et al., 2006). Hartigan (2003) studied cancer patients receiving oral chemotherapy agents and noted their success with medication safety, optimal dosing, and adherence to the treatment plan when instructed by an oncology nurse in self-assessment, management of symptoms and medication side effects, and use of compliance aids (e.g., diaries, calendars, pill-boxes with alarms). Nurses also provided telephone follow-up and triage to patients, reinforcing this support (Hartigan, 2003).
However, the ability and willingness of patients to assume this partnership role can vary depending on their health status. Many patients trust their health care providers and prefer that providers make appropriate decisions for them (Kravitz et al., 2003). In one study, for example, up to 34 percent of women recently diagnosed with breast cancer wanted to delegate all decision making to their provider (Degner et al., 1997). Another study found that 69 percent of patients with chronic conditions preferred such delegation of medical decisions (Arora and McHorney, 2000). The likelihood of preferring an active role increases with level of education and decreases significantly with age and severity of illness (Ende et al., 1989; Stiggelbout and Kiebert, 1997; Mansell et al., 2000).
Thus, consumer engagement should be viewed on a continuum from those who prefer a highly active role to those who prefer a more passive role (RWJF, 2000). For some individuals, their level of activation will change over time. Nevertheless, respect for patients’ decisions about their care and level of partnership is paramount. No less important is respect for the level of participation desired by patient surrogates when patients themselves are unable to participate.
The single most important contribution consumers can make to medication safety and good medication self-management is maintaining an up-to-date medication list that includes prescription medications, OTC drugs, and dietary supplements; the reasons for taking these products; and all