Feature

’Growing old is like being increasingly penalised for a crime you haven’t committed̵

So wrote Anthony Powell in his novel Temporary Kings — and his words ring true in the wake of revelations that some NHS patients are being denied treatment solely on grounds of age. Here, John Brazier, Paula Jones and Adam Darkins examine aspects of the relationship between elderly people and health care

The nature of health care has changed from dealing with life threatening acute illness to chronic illness, where diagnosis and treatments are often uncertain.

The health needs of the elderly are especially likely to be related to chronic illness, and doctors frequently do not know which is the best way to proceed with a patient. At the King’s Fund Centre we are looking at ways to involve patients more in decisions about the health care they receive. This requires that doctors share uncertainties as well as certainties with patients, and recognises the contribution patients can and should make to decision-making about their care.

One project is evaluating the use of an interactive video system to provide support for patients and doctors making shared decisions about care. Patients receive information about the risks and benefits of treatments to help them decide what treatment they would prefer — in this case, in the treatment of prostate disease in elderly men.

Prostate disease is very common in older men. One of the main symptoms is difficulty in urinating. The standard operation is often described as simple plumbing, but in a proportion of men symptoms persist or even worsen after the operation. The risks and benefits of surgery need to be carefully considered by the patient.

The project asks men what information they need before they make the choice whether to have surgery or not. The original video on treatment for prostate disease was made in the US and we are currently using it as a base for producing a video in this country.

The project explores the uncertainties about the disease and the need for an operation. Individual patients see the surgeon in the usual way, and are offered a choice: surgery, drugs, or watch and wait. Then they watch the video — with their partner, if they have one — and with a nurse counsellor available. The patient then negotiates the decision with the consultant.

Interactive video personalises information. It provides an opportunity for patients to hear people with similar health problems share their differing experiences. It means that patient and clinician are using the same information, which goes some way to redressing the power imbalance in the consultation.

Video is a particular medium, and it could be argued that we should just educate doctors and nurses better rather than resort to technology. But the video allows patients as much time as they need to assimilate the information. There is rarely enough time for this during a consultation with a doctor. Preliminary experience shows that this approach does help patients share decisions with their doctors.

This is an edited version of a talk given by Paula Jones and Adam Darkins at the Health Rights AGM.