Shared decision-making in medicine: Difference between revisions

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Shared decision making is an approach where clinicians and patients communicate together using the best available evidence when faced with the task of making decisions, where patients are supported to deliberate about the possible attributes and consequences of options, to arrive at informed preferences in making a determination about the best action and which respects patient autonomy, where this is desired, ethical and legal.

One of the first instances where the term ‘shared decision making’ was used was in a report entitled the ‘President's Commission for The Study of Ethical Problems in Medicine and Biomedical Research^[1]. This work built on the increasing interest in patient-centredness and an increasing emphasis on recognising patient autonomy in health care interactions since the 1970s^[2]^[3].

Charles described a set of principles for shared decision making, stating “that at least two participants, the clinician and patient be involved; that both parties share information; that both parties take steps to build a consensus about the preferred treatment; and that an agreement is reached on the treatment to implement"^[4]. These principles rely on an eventual arrival at an agreement but this final principle is not fully accepted by others in the field^[5]. The view that it is acceptable to agree to disagree is also regarded as an acceptable outcome of shared decision making^[6].

Elwyn described a set of competences for shared decision making, which are composed of the steps of defining the problem which requires a decision, the portrayal of equipoise and the uncertainty about the best course of action, thereby leading to the requirement to provide information about the attributes of available options and support a deliberation process^[7]. An assessment scale to measure the extent to which clinicians involve patients in decision making has been developed^[8] and translated into Dutch, Chinese, French, German, Spanish and Italian (Option Instrument).

Many researchers and practitioners in this field meet every two years in the International Shared Decision Making Conference, which have been held at Oxford in 2001, Swansea 2003, Ottawa 2005, Freiburg 2007 and Boston in 2009. The next conference is scheduled to be in Maastricht 2011. To join the shared decision making listserve – send an email to Shared Decision Making Forum. Shared decision making is also closely associated with the use of decision support interventions, also known as decision aids. Much of the research and implementation studies to date are contained in the following publication: Shared Decision Making in Healthcare: Evidence-based Patient Choice. 2nd ed. Oxford: Oxford University Press, 2009^[9].

References

^ President`s Advisory Commission on Consumer Protection and Quality in the Health Care Industry (1998). "Quality First: Better Health Care for All Americans".
^ Engel GL (1980). "The clinical application of the biopsychosocial model". Am J Psychiatry. 137 (5): 535–44. PMID 7369396. {{cite journal}}: Unknown parameter |month= ignored (help)
^ Levenstein JH (1984). "The patient-centred general practice consultation". South African Family Practice. 5: 276–82.
^ Charles C, Gafni A, Whelan T (1997). "Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango)". Soc Sci Med. 44 (5): 681–92. PMID 9032835. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
^ Makoul G, Clayman ML (2006). "An integrative model of shared decision making in medical encounters". Patient Educ Couns. 60 (3): 301–12. doi:10.1016/j.pec.2005.06.010. PMID 16051459. {{cite journal}}: Unknown parameter |month= ignored (help)
^ Elwyn G, Edwards A, Kinnersley P (1999). "Shared decision-making in primary care: the neglected second half of the consultation". Br J Gen Pract. 49 (443): 477–82. PMC 1313449. PMID 10562751. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
^ Elwyn G, Edwards A, Kinnersley P, Grol R (2000). "Shared decision making and the concept of equipoise: the competences of involving patients in healthcare choices". Br J Gen Pract. 50 (460): 892–9. PMC 1313854. PMID 11141876. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
^ Elwyn G, Hutchings H, Edwards A; et al. (2005). "The OPTION scale: measuring the extent that clinicians involve patients in decision-making tasks". Health Expect. 8 (1): 34–42. doi:10.1111/j.1369-7625.2004.00311.x. PMID 15713169. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
^ Elwyn, Glyn; Edwards, Adrian (2009). Shared decision-making in health care: Achieving evidence-based patient choice (2nd ed.). Oxford University Press. ISBN 0-19-954627-4.{{cite book}}: CS1 maint: multiple names: authors list (link)

External Links

Option Instrument

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 Shared decision making is an approach where clinicians and patients communicate together using the best available evidence when faced with the task of making decisions, where patients are supported to deliberate about the possible attributes and consequences of options, to arrive at informed preferences in making a determination about the best action and which respects patient autonomy, where this is desired, ethical and legal.
 <br /><br />
-One of the first instances where the term ‘shared decision making’ was used was in a report entitled the ‘President's Commission for The Study of Ethical Problems in Medicine and Biomedical Research<ref>President's Advisory Commission on Consumer Protection and Q. Quality First: Better Health Care for All Americans. www.hcqualitycommission.gov/final. 1998.</ref>. This work built on the increasing interest in patient-centredness and an increasing emphasis on recognising patient autonomy in health care interactions since the 1970s<ref>Engel GL. The clinical application of the biopsychosocial model. Am J Psychiatry 1980;137:535-43.</ref><ref> Levenstein JH. The patient-centred general practice consultation. South African Family Practice 1984;5:276-82.</ref>.
+One of the first instances where the term ‘shared decision making’ was used was in a report entitled the ‘President's Commission for The Study of Ethical Problems in Medicine and Biomedical Research<ref>{{cite web |author=President`s Advisory Commission on Consumer Protection and Quality in the Health Care Industry |title=Quality First: Better Health Care for All Americans |date=1998 |url=http://www.hcqualitycommission.gov/final }}</ref>. This work built on the increasing interest in patient-centredness and an increasing emphasis on recognising patient autonomy in health care interactions since the 1970s<ref>{{cite journal |author=Engel GL |title=The clinical application of the biopsychosocial model |journal=Am J Psychiatry |volume=137 |issue=5 |pages=535–44 |year=1980 |month=May |pmid=7369396 |url=http://ajp.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=7369396}}</ref><ref>{{cite journal |author=Levenstein JH |title=The patient-centred general practice consultation |journal=South African Family Practice |volume=5 |issue= |pages=276–82 |year=1984}}</ref>.
 <br /><br />
-Charles described a set of principles for shared decision making, stating “that at least two participants, the clinician and patient be involved; that both parties share information; that both parties take steps to build a consensus about the preferred treatment; and that an agreement is reached on the treatment to implement"<ref>Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: what does it mean? (Or it takes at least two to tango). Soc Sci Med 1997;44:681-92.</ref>. These principles rely on an eventual arrival at an agreement but this final principle is not fully accepted by others in the field<ref>Makoul G, Clayman ML. An Integrative Model of Shared Decision Making in Medical Encounters. Patient Educ Couns 2006;60:301-12.</ref>. The view that it is acceptable to agree to disagree is also regarded as an acceptable outcome of shared decision making<ref>Elwyn G, Edwards A, Kinnersley P. Shared decision making: the neglected second half of the consultation. BJGP 1999;49:477-82.</ref>.
+Charles described a set of principles for shared decision making, stating “that at least two participants, the clinician and patient be involved; that both parties share information; that both parties take steps to build a consensus about the preferred treatment; and that an agreement is reached on the treatment to implement"<ref>{{cite journal |author=Charles C, Gafni A, Whelan T |title=Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango) |journal=Soc Sci Med |volume=44 |issue=5 |pages=681–92 |year=1997 |month=March |pmid=9032835 |url=http://linkinghub.elsevier.com/retrieve/pii/S0277953696002213}}</ref>. These principles rely on an eventual arrival at an agreement but this final principle is not fully accepted by others in the field<ref>{{cite journal |author=Makoul G, Clayman ML |title=An integrative model of shared decision making in medical encounters |journal=Patient Educ Couns |volume=60 |issue=3 |pages=301–12 |year=2006 |month=March |pmid=16051459 |doi=10.1016/j.pec.2005.06.010 |url=http://linkinghub.elsevier.com/retrieve/pii/S0738-3991(05)00178-3}}</ref>. The view that it is acceptable to agree to disagree is also regarded as an acceptable outcome of shared decision making<ref>{{cite journal |author=Elwyn G, Edwards A, Kinnersley P |title=Shared decision-making in primary care: the neglected second half of the consultation |journal=Br J Gen Pract |volume=49 |issue=443 |pages=477–82 |year=1999 |month=June |pmid=10562751 |pmc=1313449 |url=http://openurl.ingenta.com/content/nlm?genre=article&issn=0960-1643&volume=49&issue=443&spage=477&aulast=Elwyn}}</ref>.
-<br /><br />
+<br />
-[[Elwyn]] described a set of competences for shared decision making, which are composed of the steps of defining the problem which requires a decision, the portrayal of equipoise and the uncertainty about the best course of action, thereby leading to the requirement to provide information about the attributes of available options and support a deliberation process<ref>Elwyn G, Edwards A, Kinnersley P, Grol R. Shared decision making and the concept of equipoise: defining the competences of involving patients in healthcare choices. BJGP 2000;50:892-99.</ref>. An assessment scale to measure the extent to which clinicians involve patients in decision making has been developed<ref>Elwyn G, Hutchings H, Edwards A, Rapport F, Wensing M, Cheung WY, et al. The OPTION scale : measuring the extent that clinicians involve patients in decision making tasks. Health Expectations 2005;8:34-42.</ref> and translated into Dutch, Chinese, French, German, Spanish and Italian ([http://www.optioninstrument.com Option Instrument]).
-<br /><br />
-Many researchers and practitioners in this field meet every two years in the International Shared Decision Making Conference, which have been held at Oxford in 2001, Swansea 2003, Ottawa 2005, Freiburg 2007 and Boston in 2009. The next conference is scheduled to be in Maastricht 2011. To join the shared decision making listserve – send an email to [mailto:shared-l@list.msu.edu Shared Decision Making Forum]. Shared decision making is also closely associated with the use of [[decision support interventions]], also known as [[decision aids]]. Much of the research and implementation studies to date are contained in the following publication: ''Shared Decision Making in Healthcare: Evidence-based Patient Choice. 2nd ed. Oxford: Oxford University Press, 2009<ref>Edwards A, Elwyn G, editors. Shared Decision Making in Healthcare: Evidence-based Patient Choice. 2nd ed. Oxford: Oxford University Press, 2009.</ref>. [http://ukcatalogue.oup.com/product/9780199546275.do]
-<br />
+[[Elwyn]] described a set of competences for shared decision making, which are composed of the steps of defining the problem which requires a decision, the portrayal of equipoise and the uncertainty about the best course of action, thereby leading to the requirement to provide information about the attributes of available options and support a deliberation process<ref>{{cite journal |author=Elwyn G, Edwards A, Kinnersley P, Grol R |title=Shared decision making and the concept of equipoise: the competences of involving patients in healthcare choices |journal=Br J Gen Pract |volume=50 |issue=460 |pages=892–9 |year=2000 |month=November |pmid=11141876 |pmc=1313854 |url=http://openurl.ingenta.com/content/nlm?genre=article&issn=0960-1643&volume=50&issue=460&spage=892&aulast=Elwyn}}</ref>. An assessment scale to measure the extent to which clinicians involve patients in decision making has been developed<ref>{{cite journal |author=Elwyn G, Hutchings H, Edwards A, ''et al.'' |title=The OPTION scale: measuring the extent that clinicians involve patients in decision-making tasks |journal=Health Expect |volume=8 |issue=1 |pages=34–42 |year=2005 |month=March |pmid=15713169 |doi=10.1111/j.1369-7625.2004.00311.x |url=http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1369-6513&date=2005&volume=8&issue=1&spage=34}}</ref> and translated into Dutch, Chinese, French, German, Spanish and Italian ([http://www.optioninstrument.com Option Instrument]).
-== References ==
-<references />
 <br />
+Many researchers and practitioners in this field meet every two years in the International Shared Decision Making Conference, which have been held at Oxford in 2001, Swansea 2003, Ottawa 2005, Freiburg 2007 and Boston in 2009. The next conference is scheduled to be in Maastricht 2011. To join the shared decision making listserve – send an email to [mailto:shared-l@list.msu.edu Shared Decision Making Forum]. Shared decision making is also closely associated with the use of [[decision support interventions]], also known as [[decision aids]]. Much of the research and implementation studies to date are contained in the following publication: ''Shared Decision Making in Healthcare: Evidence-based Patient Choice. 2nd ed. Oxford: Oxford University Press, 2009<ref>{{cite book |author=Elwyn, Glyn; Edwards, Adrian |title=Shared decision-making in health care: Achieving evidence-based patient choice |publisher=Oxford University Press |year=2009 |isbn=0-19-954627-4 |edition=2nd |url=http://ukcatalogue.oup.com/product/9780199546275.do}}</ref>.
+== References ==
+{{reflist}}
 == External Links ==
 [http://www.OptionInstrument.com Option Instrument]
-<br />
 == See also ==