Examples of different types of patient‐mediated interventions

Possible mechanisms of action

How it might have positive effects

How it might have adverse effects

Patient information where patients are informed about recommended care

Information to patient from others → impact on healthcare professionals' performance

Giving recommendations or evidence to patients might lead them to ask for recommended care, and professionals might respond by providing it.

Healthcare professionals might feel threatened by this or disagree with the information given to patients. Patients might become distrustful of the healthcare professionals.

Patient education/training/counselling to increase patients' knowledge about their condition

Activation of patient by others → impact on healthcare professionals' performance

Education/training/counselling to increase patients' knowledge about their condition, which can increasing their self‐efficacy and self‐care skills. This in turn, might encourage patients to get more involved in decisions about their treatment and management and professionals might respond by providing recommended healthcare.

Healthcare professionals might feel threatened by this or disagree with the patient. It might increase healthcare professionals' burden if they need to spend more time finding answers to patients' questions. Patients might feel more uncomfortable if they have more questions but do not feel comfortable asking them. Patients might not like the answers they are given. This might lead to longer consultations without measurable improvements in the quality of care.

Patient feedback about clinical practice

(collecting information from patients and giving it to professionals before, during or after an encounter)

Information to healthcare professionals from patients → impact on healthcare professionals' performance

Clinical performance feedback from patients might ensure that professionals get important information that they might otherwise not have received. This information might prompt professionals to improve their practice and provide recommended healthcare.

This might distract healthcare professionals from focusing on other things or lead to longer consultations without measurable improvements in the quality of care, if the information that is collected turns out not to be important.

Patient decision aids to ensure that the choices about treatment and management reflect recommended care and the patients' values and preferences

Activation of patient by others → impact on healthcare professionals' performance

Giving recommendations or evidence to patients and encouraging them to engage with their own values and preferences for treatment options might encourage healthcare professionals to provide recommended healthcare.

Healthcare professionals might feel threatened by this or disagree with the patient. It might increase healthcare professionals' burden if they need to spend more time finding answers to patients' questions. Patients might feel more uncomfortable if they have more questions but do not feel comfortable asking them. Patients might not like the answers they are given. This might lead to longer consultations without measurable improvements in the quality of care.

Patients, or patient representatives, being members of a committee or board

Information to healthcare professionals from patients → impact on healthcare professionals' performance

Patients being part of a prioritisation or agenda deciding process at the health system level might influence professional practice and result in giving patients the recommended healthcare

Healthcare professionals on the committee or board might feel threatened by this or disagree with the patients' prioritisation or decisions. This might in turn, lead to poor implementation of recommendations or guidelines made within this format.

Patient‐led training or education of healthcare professionals

Information and/or activation of healthcare professionals by patients → impact on healthcare professionals' performance

Patients being part of the education or training of healthcare professional might influence professional practice and result in providing recommended healthcare

Healthcare professionals might feel threatened by this or disagree with the patient trainer or educator. This might result in non‐adherence to the care recommended in this training or education.