Patient Involvement in Decision-Making of Nursing Care from the Nurses’ Perspectives

@#Introduction: High-quality care renders patients to be fully informed and involved in the decision-making process. A literature review also reveals that the involvement of patients in healthcare has been associated with improved clinical outcomes. However, it rarely happens as several studies demonstrated that patient involvement in decision-making is lacking worldwide. Hence, health professionals, especially nurses, play an important role in patient involvement in decision-making as they are mostly engaged with patients during the care plan. This study aimed to assess the nurses’ perceptions and their role on patient involvement in nursing care decision-making. Method: A cross-sectional descriptive study was conducted at one of the university hospitals in Malaysia. About 105 nurses from 3 major departments (internal medicine, general surgery, and orthopaedic) were involved in this study. The data were analysed using IBM SPSS Statistics version 25. Results: The result showed that most of the nurses agree their patient involvement in decision-making relates to their encouragement to participate as well as having opportunity and enough information to participate. However, many of the nurses believe that they have to decide for their patients. Besides, a significant association between nurses’ years of service and their perception of patient’s involvement in decision-making (p = 0.01) was noted. Similarly, there is a significant association between the nurses’ department and their preferred role with p-value of 0.001 (p < 0.05). Conclusion: This study indicates the need to further improve nurses’ awareness of the importance and benefits of patient involvement in decisions related to their nursing care.

Engajamento do paciente em programas de quedas hospitalares: percurso para a elaboração de um manual / Patient engagement in hospital falls programs: route to the elaboration of a manual

Resumo: Introdução: Trata-se da elaboração de um manual sobre estratégias de engajamento do paciente e seu acompanhante na identificação do risco de queda e ações de prevenção de quedas em ambiente hospitalar, que faz parte do projeto "Difusão e adoção do programa Fall Tailoring Interventions for Patient Safety - Fall TIPS", que vem sendo desenvolvido em hospital universitário do sul do Brasil. Objetivo: a elaboração de manual sobre estratégias de engajamento do paciente e seu acompanhante em programas de prevenção de queda. Método: Trata-se de uma pesquisa do tipo qualitativa, exploratória, descritiva e de produção tecnológica, composta por duas fases: a) entrevistas com pacientes que apresentaram o evento adverso queda hospitalar durante internação hospitalar, e/ou com seus acompanhantes, analisadas a partir da técnica de análise de conteúdo; e b) produção tecnológica para a elaboração do manual. Resultados: Nas entrevistas realizadas foi possível observar a recorrência de alguns temas principais: "A gente não sabia: dificuldades e inquietações na percepção dos riscos"; "Medo e insegurança: o manejo emocional como ferramenta da clínica no risco de queda"; "Relação da equipe de saúde com os cuidadores como ferramenta de suporte ao engajamento do paciente", que subsidiaram a elaboração do manual. Os resultados evidenciam lacunas na efetividade da comunicação entre os envolvidos no processo de identificação de riscos e manejo das intervenções relacionadas a cuidados seguros e trazem sugestões para superação do desafio por parte dos profissionais da saúde, em desenvolver práticas mais colaborativas. Sem essa abordagem, o paciente desenvolve sentimentos de medo e insegurança, comprometendo o seu cuidado e segurança. Produto e registro: O "Manual sobre Estratégias de Engajamento em Programas de Prevenção de Quedas Hospitalares", registrado na Câmara Brasileira do Livro. Conclusão: O manual subsidia a adoção de estratégias de prevenção à ocorrência de quedas em ambiente hospitalar, levando em consideração a adesão de uma cultura de segurança que conduza a uma prática assistencial de qualidade e, consequentemente, à redução de quedas.

Abstract: Introduction: A manual on strategies for engaging patients and their companions in identifying the risk of falling and actions to prevent falls in the hospital environment was prepared, as a part of the project "Dissemination and adoption of the Fall Tailoring Interventions for program Patient Safety - Fall TIPS", that is being developed in a university hospital in southern Brazil. Objective: the development of a manual on patient and companion engagement strategies in fall prevention programs. Method: A qualitative, exploratory, descriptive and of technological production research was performed, consisting of two phases: a) interviews with patients (and/or their companions), who had experienced a fall during hospitalization. The content analysis technique was used; and b) the production/preparation of the manual. Results: In the interviews results, it was possible to observe the recurrence of the themes: "We didn't know: difficulties and concerns in the perception of risks"; "Fear and insecurity: emotional management as a clinical tool for managing the risk of falling"; "Relationship between the health team and caregivers as a support tool for patient engagement", which supported the preparation of the manual. Also, they showed gaps in communication effectiveness among those involved in the process of identifying risks and managing interventions related to safe care and bring suggestions for overcoming the challenge on the part of health professionals, in developing more collaborative practices. Without this approach, the patient develops feelings of fear and insecurity, compromising their care and safety. Product: The "Manual on Engagement Strategies in Hospital Fall Prevention Programs", it was registered at Câmara Brasileira do Livro. Conclusion: The manual supports the adoption of prevention strategies against the occurrence of falls in the hospital environment, taking into account the adherence of a safety culture that leads to a quality care practice and, consequently, to the reduction of falls.

A study on the effect of the strategy of patient for patient safety in hospitalized patients with traumatic fracture / 中国实用护理杂志

Objective:To explore the clinical significance of patient for patient safety strategy in inpatients with traumatic fracture.Methods:Convenience sampling method was used to randomly select 120 patients with traumatic fracture from September to December 2019 in the Department of Orthopaedics and Traumatology of a third-class hospital of Zibo city. Sixty patients with traumatic fracture treated from September to October 2019 were the control group, and 60 patients with traumatic fracture treated from November to December 2019 were the intervention group. The control group implemented routine safety management, and the intervention group implemented patient for patient safety strategy on the basis of routine safety management. The general information questionnaire, Hamilton Anxiety Scale (HAMA), patient for patient safety attitude questionnaire, incidence of adverse events during hospitalization and inpatient satisfaction scale were used to evaluate the effect after application.Results:HAMA score was 17.6±3.4,11.5±2.7 3 days after operation and at discharge in the intervention group, whcih were significantly lower than 23.3±4.3, 14.3±3.2 in the control group ( t values were 7.919, 6.912, P<0.001). The score of patients for patient safety attitude questionnaire was significantly higher in the intervention group at discharge compared with one day after operation ( t values were 3.246-6.558, P<0.001), as well as compared with those in the control group ( t values were 2.251-6.445, P<0.05). The total incidence rate of adverse events during hospitalization and satisfaction degree was 6.7%(4/60) and 95.0% (57/60) in the intervention,better than 13.3%(8/60), 90.0% (54/60) in the control group ( χ2 values were 7.260,16.008, P<0.001). Conclusions:The patient for patient safety strategy can effectively alleviate patients' negative psychological emotions, enhance patients' attitude to participate in safety behaviors, increase their enthusiasm to participate in safety behaviors, reduce the occurrence of adverse events during hospitalization, and improve patients' satisfaction with hospitalization.

Factores asociados al paciente empoderado en el tema de coronavirus en el Perú

RESUMEN Introducción: Para combatir al Coronavirus se requiere saber cómo afrontarlo, saber sus características más importantes y reconocer que lo más sustancial es generar medidas higiénicas básicas. Objetivo: Determinar los factores asociados al paciente empoderado en el tema de coronavirus. Métodos: Estudio transversal-analítico, con encuesta autoaplicada de carácter multicéntrico realizado en Perú entre marzo y mayo de 2020. El "paciente empoderado" se definió mediante encuesta de diez preguntas (alpha de Cronbach: 0,83); cuatro: conocimiento básico, de la gravedad y del contagio; dos: en quienes genera más daño y cuatro: medidas de protección. Se hizo la sumatoria del total de los puntajes y se cruzó versus cuatro variables socio-educativas. Resultados: De los 4167 encuestados; la mayoría sabía las medidas para evitar el contagio: el lavado de manos y estornudar adecuadamente (ambas con 65 % de personas muy de acuerdo). En el análisis multivariado, los del nivel técnico tenían un menor empoderamiento con respecto a la enfermedad (coeficiente: 0,39; IC95%: 0,15-0,98; p=0,046); además, en comparación con los encuestados que no tenían riesgo de complicaciones, los que eran del personal de salud sin riesgo (coeficiente: 1,77; IC95%: 1,01-3,09; p= 0,045) y los del personal de salud que tenían algún riesgo (coeficiente: 4,73; IC95%: 1,46-15,31; p= 0,010), fueron los más empoderados con respecto a la enfermedad; todas estas comparaciones se ajustaron por el sexo, la edad y el lugar de encuestado. Conclusiones: El personal de salud, debido a su actividad laboral, son lo más empoderados con respecto a COVID-19 y tienen mejor conocimiento en los temas de transmisión y prevención.

ABSTRACT Introduction: The fight against coronavirus infection requires knowledge about how to cope with this disease, as well as awareness of its main characteristics and the leading role played by basic hygiene actions. Objective: Determine the factors associated to patient empowerment in the context of coronavirus infection. Methods: A multicenter analytical cross-sectional study based on a self-applied survey was conducted in Peru from March to May 2020. The "empowered patient" was defined by a 10-question survey (Cronbach's alpha: 0.83); four: basic knowledge about severity and contagion; two: who are the most harshly affected, and four: protection measures. Total scores were added together and compared with four socioeducational variables. Results: Most of the 4 167 respondents were aware of the measures required to prevent contagion: hand and respiratory hygiene (both with 65% respondents very much in agreement). Multivariate analysis revealed that people with a technical educational level were less empowered about the disease (coefficient: 0.39; CI95%: 0.15-0.98; p=0.046). Comparison between respondents under no risk for complications, the health personnel (coefficient: 1.77; CI 95%: 1.01-3.09; p=0.045) and the health personnel under some sort of risk (coefficient: 4.73; CI 95%: 1.46-15.31; p=0.010) showed that the latter were the most empowered about the disease. These comparisons were adjusted for respondent sex, age and location. Conclusions: The health personnel were found to be the most highly empowered about COVID-19, due to the job they do, and showed to have the broadest knowledge about transmission and prevention topics.

Tecnologia educativa para promoção de ações de segurança do paciente em uma maternidade / Educational technology to promote patient safety actions in a maternity hospital

Introdução: Potenciais riscos aos pacientes são intrínsecos à assistência à saúde, sendo que na maternidade, a ocorrência de eventos adversos pode repercutir em danos a mulher e ao recémnascido (RN). Diante disso, políticas públicas estabelecem ações de melhoria da assistência por meio da corresponsabilização e participação ativa dos pacientes e acompanhantes no cuidado e na prevenção de incidentes. Nesse contexto, a literatura sugere o desenvolvimento de tecnologias educativas (TE) para aperfeiçoar a comunicação, aumentar a capacidade de escuta e engajar o paciente e família na segurança do paciente (SP). Entretanto, as evidências sobre o desenvolvimento e utilização de TE em busca do maior envolvimento do acompanhante e do paciente na SP na maternidade, especialmente com a participação desses atores são insuficientes. Objetivos de pesquisa: Conhecer as percepções e as experiências de pacientes, acompanhantes e profissionais de saúde da maternidade sobre a participação da paciente e do acompanhante na segurança da paciente e do RN. Objetivo de prática: Elaborar e avaliar uma tecnologia educativa para promoção do envolvimento das pacientes internadas na maternidade e seus acompanhantes nas ações do cuidado seguro. Método: O estudo seguiu os preceitos metodológicos da Pesquisa Convergente-Assistencial e sustentou-se nos fundamentos teóricos de Paulo Freire. Foi realizado na maternidade de um hospital público de Belo Horizonte e a produção de dados foi dividida em três etapas. A primeira etapa subsidiou a construção da cartilha através de entrevistas para conhecer as percepções e o conhecimento dos participantes sobre a SP e a participação da paciente e do acompanhante na segurança; e identificar as barreiras que dificultam colocar em prática as ações de SP. Participaram dessa etapa 13 profissionais de saúde, 11 pacientes e 06 acompanhantes. Na segunda foi desenvolvida a TE em forma de cartilha e na terceira, a mesma foi avaliada pelos participantes. Na última etapa aceitaram continuar participando da pesquisa os 13 profissionais da saúde, 08 pacientes e 05 acompanhantes. A coleta de dados ocorreu por meio de entrevista semiestruturada e registro de diário de campo. A análise dos dados foi realizada pela análise de conteúdo e foram criadas duas categorias provenientes da primeira etapa: Saberes e experiências sobre a segurança da paciente e do RN na maternidade e Desafios para o envolvimento da paciente e acompanhante nas ações de segurança. Resultados: Na primeira categoria os achados evidenciaram que as pacientes e os acompanhantes esboçaram diferentes entendimentos sobre a SP, sendo que a maioria apresentava compreensão limitada sobre o tema e desconhecia como poderiam contribuir para SP. Os profissionais enfatizaram que as pacientes e os acompanhantes se envolvem pouco na SP e poderiam ser mais informados e estimulados pela própria equipe. A segunda categoria apontou as fragilidades para a participação da paciente e acompanhante nas ações de segurança, como a falta de conhecimento, diálogo e escuta, e a posição autoritária de alguns profissionais. Os achados da primeira etapa contribuíram para a construção da TE, no formato de cartilha. Na terceira etapa, os participantes avaliaram a TE como sendo um material importante para impulsionar a participação das pacientes e acompanhantes na SP. Conclusão: O processo interativo e dialogado com os participantes possibilitou a criação da TE como ferramenta importante no envolvimento das pacientes e acompanhantes nas ações de SP. Essa experiência vai ao encontro do pensamento de Paulo Freire que afirma que, o educador deve reconhecer o educando têm saberes, experiências e leituras de mundo próprias, sendo o respeito essencial para influenciar no desenvolvimento de novos saberes.

Potential risks to patients are intrinsic to health care, and in maternity hospitals, the occurrence of adverse events can affect women and newborns (NB). Therefore, public policies establish actions to improve care through co-responsibility and active participation of patients and caregivers in the care and prevention of incidents. In this context, the literature suggests the development of educational technologies (ET) to improve communication, increase listening skills and engage the patient and family in patient safety (PS). However, the evidence on the development and use of ET in search of greater involvement of the companion and the patient in PS in the maternity hospital, especially with the participation of these actors, is insufficient. Research objectives: Know the perceptions and experiences of patients, companions and health professionals in the maternity ward about the participation of the patient and companion in the safety of the patient and the NB. Practice objective Develop and evaluate an educational technology to promote the involvement of patients admitted to the maternity ward and their companions in safe care actions. Method: The study followed the methodological precepts of the Convergent Care Research and was supported by Paulo Freire's theoretical foundations. It was carried out in the maternity of a public hospital in Belo Horizonte and data production was divided into three stages. The first stage supported the construction of the booklet through interviews to learn about the participants' perceptions and knowledge about PS and the patient's and companion's participation in safety; and identify the barriers that make it difficult to put PS actions into practice. Thirteen health professionals, 11 patients and 06 caregivers participated in this stage. In the second, the ET was developed in the form of a booklet and in the third, it was evaluated by the participants. In the last stage, the 13 health professionals, 08 patients and 05 companions agreed to continue participating in the research. Data collection took place through semi-structured interviews and field diary records. Data analysis was performed using content analysis and two categories were created from the first stage: Knowledge and experiences about patient and newborn safety in the maternity ward and Challenges for the involvement of the patient and companion in safety actions. Results: In the first category, the findings showed that patients and caregivers outlined different understandings about PS, and most of them had limited understanding of the topic and did not know how they could contribute to PS. Professionals emphasized that patients and companions are little involved in PS and could be more informed and encouraged by the team itself. The second category pointed out the weaknesses for the participation of the patient and companion in safety actions, such as the lack of knowledge, dialogue and listening, and the authoritarian position of some professionals. The findings of the first stage contributed to the construction of the ET, in the form of a booklet. In the third stage, participants assessed ET as being an important material to boost the participation of patients and caregivers in the PS. Conclusion: The interactive process and dialogue with the participants enabled the creation of ET as an important tool in the involvement of patients and caregivers in PS actions. This experience is in line with the thought of Paulo Freire who states that the educator must recognize that the student has their own knowledge, experiences and readings of the world, with respect being essential to influence the development of new knowledge.

Inpatients' experience in participating in patient safety:a qualitative research / 现代临床护理

Objective To explore the experience of inpatients in self-safety management in order to take relevant measures to meet the needs of patients to promote the patient's participation in patient safety management. Methods In-depth semi-structured interviews were undertaken and a total of 11 inpatients in one first-class grade A hospital were interviewed.The acquired data by inter-viewing were analyzed using Colaizzi's phenomenological methodology. Result Three themes were extracted:(1)feeling poor commu-nication with medical staffs during participation; (2)no access to disease-related information; (3)inability to participate in self-safety management. Conclusions There are still many problems in the management and implementation of patients'participation in patient safety. The relevant departments should take appropriate measures to promote communication between medical staffs and patients, strengthen patient health education and optimize access to information for patients.

Nurses' Opinions of Patient Involvement in Relation to Patient-centered Care During Bedside Handovers

PURPOSE: Advocates for societal change and consumerism have been instrumental in popularizing patient involvement in various aspects of health care. Patient involvement in bedside handovers during shift changes should facilitate patient-centered care. This study's purpose was to explore Malaysian nurses' opinions about patient involvement during bedside handovers, and whether patient involvement during bedside handovers reflected patient-centered care. METHODS: A qualitative study with four focus-group discussions was conducted with 20 registered nurses from general wards in a Malaysian public hospital. Semi-structured interviews were used to elicit participants' opinions. NVivo 10 software was used for data management and content analysis was used to analyze the data. RESULTS: Several participants used inconsistent methods to involve patients in bedside handovers and others did not involve the patients at all. The participants' interpretations of the concept of patient-centered care were ambiguous; they claimed that patient involvement during bedside handovers was impractical and, therefore, not reflective of patient-centered care. Some nurses' subjective views of patient involvement as impractical during bedside handovers were manifested in their deliberate exclusion of patients from the handover process. CONCLUSIONS: Changes in patient involvement and nursing practices congruent with patient-centered care require that nurse educators in hospital settings reform nursing education to focus on fostering of communication skills needed to function in nurse-patient partnerships. Guidelines for patient involvement consistent with patient-centered values should be developed using ward nurses' subjective views and introduced to all registered nurses in practice.

Health care professionals′attitude of patients involvement in patient safety and its influencing ;factors / 中国实用护理杂志

Objective To investigate health care professionals′attitude of patient involvement in patient safety and analyze its influencing factors. Methods A convenience sample of 946 health care professionals recruited from twelve hospitals in Shanghai was employed for a cross-sectional survey. Results The general attitudes of patient involvement in patient safety scored 3.86 ±0.56, the perception of the content of patient involvement scored 3.97±0.54, the average score of caring involvement (4.12±0.59) was larger than the average score of decisive involvement (3.88±0.58), the average score of complaining involvement was the least (3.39±0.81), the difference had statistical significance (F=583.797, P<0.01). The regression analysis showed that identity, professional title, hospital grade influenced health care professionals′general attitude of patient involvement in patient safety and that identity, hospital grade influenced health care professionals′attitude of the content of patient involvement. Conclusions In health care professionals′opinion, patient involvement in patient safety has both advantages and disadvantages. They preferred to caring involvement, followed by decisive involvement, then complaining involvement. So, hospital managers should view patient involvement in patient safety discriminately and construct rational involvement model ofpatients willing, medical support, promote interaction and harmony build.

A participação do paciente na educação médica: reflexões sobre discursos e experiências no Reino Unido / Patient participation in medical education: reflections on discourses and experiences in the United Kingdom

Este artigo faz uma revisão geral e levanta questões sobre os discursos dominantes da participação do paciente na educação médica no Reino Unido. Chamando atenção para as dimensões negligenciadas de práticas participativas na pesquisa e pedagogia da educação médica, a discussão dos autores aponta as seguintes questões: quem é o "paciente" nestas práticas de participação? A participação aborda questões relacionadas à epistemologia médica? Os autores sugerem que estas questões deveriam ser centrais para qualquer desenvolvimento na pesquisa e prática em educação médica para abordagens da atenção centradas no paciente e nas relações com pacientes para assim serem traduzidas através de uma retórica política, para a prática clínica do cotidiano.

This paper provides an overview of, and raises questions about, the dominant discourses of patient participation in medical education in the UK. Drawing attention to neglected dimensions of participatory practices in medical education research and pedagogies, the author's discussion addresses the following questions: Who is the 'patient' in these practices of participation? What does patient participation in teaching activities do to the power relations of medicine? Does participation call into question medical epistemologies? The author suggests that these questions should be central to any developments in medical education research and practice if patient-centred and relationship-centred approaches to care are to translate from policy rhetoric into everyday clinical practice.

The designing of will tendency scale for inpatients′ articipation in patients for patient safety and the research in its structure of the scale / 实用医学杂志

Objective To design patient paticipatin in patient safety willness and behavior scale (PSWBS) and check its validity and explore structure model. Methods Based on the related literature at home and abroad , the theoretical model was developed on the basis of preliminary survey questionnaire and the formal scale. Preliminary survey by questionnaire was carried out on sample 1, through item analysis, exploratory factor analysis and confirmatory factor analysis , reliability analysis , correlation analysis , and binary content validity test scale evaluation. Results The scale was composed of four dimensions of 14 items , qualified for the theoraticl research of a scale in terms of its internal consistency reliability , content validity , structure validity associated with the school. Conclusion The scale is good at the reliability and validity , suitable for measuring the hospitalized patients′ participation in willingness to maintain their own medical treatment was safe , and mainly adopts propensity to maintain their own medical safety behavior.

An Experience of Patient Involvement in the Pre-Transfusion Checking Process: A Single Center Study / 대한수혈학회지

BACKGROUND: Correct transfusion of blood product to the right patient requires multiple processes. Errors occurring in the pre-transfusion checking step can result in a serious incident. The role of patients in the safe blood transfusion practice has been investigated. METHODS: We have adopted patient involvement in bedside checking using patient's signature since 2010. We conducted a retrospective review of transfusion medical records during January 2013. The signatures of doctors, nurses, and patients were audited and the reasons for omitting patient's signature were examined. RESULTS: The practice of patient's signature was performed after the problems of procedures were improved. A total of 4697 blood products for 576 patients were issued. The first transfused products were 426 units of RBC (74.0%), 56 units of platelet (9.7%), and 34 units of fresh frozen plasma (5.9%). Completion of patient's signature was observed in 336 patients (63.5%). The reason for omitting patient's signature was operation (104, 18.1%), unclear consciousness or sedation (75, 13.0%), and neonate or infancy (7, 1.2%). CONCLUSION: Patient involvement in the pre-transfusion checking process by writing down the patient's own signature could be achievable. In case of no patient's signature as with an operation, sedation, and neonate or infancy, specific attention is required to ensure a safe transfusion practice.

Procesos de incorporación de la perspectiva de los usuarios al desarrollo de guías de práctica clínica-revisión de literatura / The process of incorporating a user perspective to the development of clinical practice guidelines-literature reviewing / Processo de incorporação da perspectiva dos usuários no desenvolvimento de guias de prática clinica-revisão de literatura

Con el objetivo de identificar metodologías para la identificación e incorporación efectiva de las consideraciones y perspectiva de los usuarios al desarrollo de Guías de Práctica Clínica, se realizo una revisión sistemática de la literatura disponible. Un total de 729 artículos fueronidentificados a partir la búsqueda inicial, de estos, 18 cumplieron los criterios y fueron incluidos en la revisión. Los artículos fueron valorados según calidad metodológica y se extrajo de ellos lainformación relevante. No se encontraron artículos metodológicos que describieran o evaluaran una metodología explicita para incorporar las consideraciones de los pacientes en el desarrollo de GPC. Las técnicas más utilizadas para estos procesos son las formales de consenso tales como Delphi, grupos focales, reuniones de análisis de los interesados, encuestas, escalas de preferencias y talleres. Las experiencias reportadas coinciden en la necesidad de vincular a lospacientes durante las etapas de priorización y aprobación de las recomendaciones...

In order to identify methodologies for effective identification and incorporation of the user considerationsand perspective to the development of clinical practice guidelines, a systematic review of the literature was conducted. A total of 729 articles were identified from the initial search of these, 18 met the criteria and were included in the review. The items were valued according to methodological quality and extracted relevant information from them. No methodological itemswere found that described or evaluated a specific methodology that incorporates considerations of the patients in the development of GPC. The techniques used for these processes were the formal ones such as Delphi, focus groups, stakeholder analysis, surveys, workshops and preference scales. The reported experiences agree on the need to link patients during the stages of prioritization and approval of the recommendations...

In order to identify methodologies for effective identification and incorporation of the user considerationsand perspective to the development of clinical practice guidelines, a systematic review of the literature was conducted. A total of 729 articles were identified from the initial search of these, 18 met the criteria and were included in the review. The items were valued according to methodological quality and extracted relevant information from them. No methodological items were found that described or evaluated a specific methodology that incorporates considerations of the patients in the development of GPC. The techniques used for these processes were theformal ones such as Delphi, focus groups, stakeholder analysis, surveys, workshops and preferencescales. The reported experiences agree on the need to link patients during the stages of prioritization and approval of the recommendations...