Decision Making

Advancing healthcare with shared decision-making

Thomas Bosshard
  • Thomas Bosshard

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  • Decision Making

For most medical decisions, more than one reasonable option exists. However, each option involves different combinations of possible therapeutic or side effects. Traditionally, doctors make these decisions for their patients with little discussion about the patient’s preferences. This model of decision-making – choosing a course of action in the patient’s best interest but without the patient’s consent – is known as paternalism. Practice standards have shifted in recent years from a paternalistic model to one based on engaging patients in decision making. More and more, shared decision making (SDM) between patients and medical providers is gaining acceptance as medical best practice.

Shared decision-making – a central feature of patient-centered care (PCC) – is a process that engages patients in a dialogue with their medical providers to help them choose the healthcare options that best suit their values and preference. Both parties share information: the healthcare professional describes different possible courses of action with their risks and benefits, whereas the patient expresses his or her preferences and values. Both parties take steps to build a consensus about the preferred treatment with the aim of reaching an agreement about the treatment that is to be implemented.

In numerous efforts to advance health care reform, shared decision-making (SDM) has taken center stage. It has been contrasted against other medical decision-making models like paternalism, informed choice, interpretative decision-making, etc., leading to the proposal of a continuum ranging from patient-driven to physician-driven decisions in which patients can choose how much responsibility they want to take for medical choices.

Many studies suggest that SDM improves health outcome, compliance with treatment as well as patient satisfaction. As a result, leading care organizations in Europe and the United States advocate shared decision making. This has spurred the development of patient decision aids – interactive educational tools that complement the physician-patient dialogue. A high-quality decision aid should not only help patients understand the treatment options available to them and their consequences, they should also be designed to promote clarification of the patient’s values and to provide guidance through the decision process. Some offer narratives from other patients who had similar choices to make or comments by medical experts and a library of further articles from which both patient and physician can benefit.

However, for shared decision making to gain ground in healthcare settings, patients need to be educated about the essential role they play in decision making. They should be able to ask questions without censure from their clinicians or consider options without their clinicians labeling the decision “wrong” on the basis of different values and preferences.

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