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Patient education, nudge, and manipulation: defining the ethical conditions of the person-centered model of care

Authors Reach G

Received 1 November 2015

Accepted for publication 17 February 2016

Published 5 April 2016 Volume 2016:10 Pages 459—468

DOI https://doi.org/10.2147/PPA.S99627

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Doris Leung

Peer reviewer comments 2

Editor who approved publication: Dr Johnny Chen

Gérard Reach1,2

1Department of Endocrinology, Diabetes and Metabolic Diseases, Avicenne Hospital AP-HP, 2EA 3412, Centre de Recherche en Nutrition Humaine Ile-de-France (CRNH-IDF), Paris 13 University, Sorbonne Paris Cité, Bobigny, France

Abstract: Patient education (PE) is expected to help patients with a chronic disease to manage their lives and give them the possibility of adopting, in an appropriate manner, beneficial changes in health behaviors that are prescribed by their physicians. It is aimed at delineating, agreeing on, and implementing a patient’s personal action plan and is therefore an essential constituent of the person-centered model of care. The aim of this article is to examine the idea that PE may sometimes be a manipulation that is organized for the good of patients in a paternalistic framework. Theoretically, PE differs from manipulation by addressing the reflective intelligence of patients in full light and helping them make autonomous choices. In this article, we examined some analogies between PE and nudge (ie, techniques used to push people to make good choices by organizing their environment). This analysis suggests that PE is not always as transparent and reflective as it is supposed to be and that unmasking these issues may be useful for improving the ethical quality of educational practice that must be performed in a framework of a trusting patient–doctor relationship. Under this condition, PE may sometimes represent a form of persuasion without being accused of patient deception and manipulation: trust is therefore the core of the person-centered model of care.

Keywords: patient education, adherence, autonomy, nudge, persuasion, manipulation, deception, trust, person-centered care model, shared decision-making

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