Featured Shared Decision Making PublicationsView all results of this resource type.
The objective of this study was to learn how decisions were made for two major preference-sensitive interventions: prostate cancer surgery and coronary artery stenting. Through a mail survey of probability samples of patients who underwent these two procedures, the authors found that while prostate cancer surgery patients reported more involvement in the decision making process than elective stent patients, both reports illustrated the need for increased efforts to inform and involve patients facing preference-sensitive intervention decisions.
Policies to promote shared decision making are becoming prominent in the United States, Canada, and United Kingdom. This is partly because of a recognition of the ethical imperative to properly involve patients in decisions about their care and partly because of the acrruing evidence that the approach has benefits. Shared decision making is an approach where clinicians and patients make decisions together using the best available evidence.
Posted in Health Care Policy, Patient Involvement, SDM Implementation
Tagged Angela Coulter, decision making, evidence-based medicine, Glyn Elwyn, NHS, patient autonomy, patient engagement, patients, shared decision making
Shared decision making (SDM) is a process in which patients are encouraged to participate in selecting appropriate treatments or management options. Not being properly told about their illness and the options for treatment is the most common cause of patient dissatisfaction. Most patients nowadays want more information and a greater say in decisions about how they will be treated. In SDM, patients are involved as active partners with the clinician in clarifying acceptable medical options and choosing a preferred course of clinical care.
Occasionally, all citizens have to make important health decisions that affect health outcomes. Strategies to support patient education and engagement should therefore be a fundamental plank of health policy. Also, patients can play an important role in understanding the causes of illness, protecting their health and taking appropriate action, choosing appropriate treatments for acute episodes of ill health, and managing chronic illness. These roles must be recognized and supported.
There is much evidence that engaging patients in treatment decisions and supporting their efforts at self-care can lead to beneficial outcomes. Patients who are active participants in a shared decision-making process have a better knowledge of treatment options and more realistic perceptions of likely treatment effects. The resulting treatment choices are more likely to concur with their preferences and attitudes to risk. Actively engaged patients are also more likely to adhere to treatment recommendations, and less likely to select expensive procedures. However, patients' desires to play and active role in decision making varies, and, according to Cox et al., GPs are not very good at predicting what role patients want to play. What should be done about this problem?
This article reports on the International Patient Decision Aid Standards Symposium held in 2006 at the annual meeting of the Society for Medical Decision Making in Cambridge, Massachusetts. The symposium featured a debate regarding the proposition that "decision aids are the best way to improve clinical decision making."
Policymakers increasingly believe that encouraging patients to play a more active role in their health care could improve quality, efficiency, and health outcomes. But critics have dismissed talk about patient engagement and patient centred care as political correctness -- a misplaced concern with the "touchy feely" aspects of health care, with no scientific basis and little relevance to the quest for excellence in clinical care. Who is right? To what extent is the planned shift towards greater patient engagement supported by robust research evidence?
Good quality health information is essential for greater patient involvement in healthcare. Patients and the public require information that is timely, relevant, reliable and easy to understand. This is an essential component of any strategy to promote health literacy, self-care, choice- shared decision-making, medication adherence and self-management of chronic disease. Patients have many decisions to make about their healthcare and, like all decision-makers, they require information to inform their choices. Reliable information is also essential to help patients understand their health problems and how to deal with them.
Health systems throughout the world are searching for ways of making their services more responsive to patients and the public. The WHO has been encouraging this by including indicators of responsiveness in its World Health Reports. Many European governments have recognized that the future of socialized health care services depends on their ability to keep abreast of changing needs and respond to these in an appropriate way in order to sustain public confidence. Regular surveys of the views and experiences of patients and the public are beginning to be seen as an indispensable addition to the panoply of performance indicators used for monitoring the effectiveness of health policy. We report here a survey of random population samples in eight European countries focusing on public views of the quality of doctor-patient communications and opportunities for involvement in choice of providers and treatments.
Posted in Health Care Policy, Patient Involvement, SDM Implementation
Tagged Angela Coulter, choice of provider, decision making, doctor-patient communication, health care, health care systems, patients, primary care, shared decision making, treatment decisions, World Health Organization
There is considerable debate about when, in which circumstances, and to what extent, patients should be encouraged to participate in decisions about their care. This issue of "Health Expectations" includes some important contributions to the debate. Many advocates of shared decision-making suggest it should be restricted to preference-sensitive decisions, i.e. those where the patient's values out to guide the choice. Informed consent, on the other hand, is perceived to be appropriate, and indeed necessary, for all decisions of significant risk even if there is only one treatment possibility.
The rationale for decision aids is addressed in the accompanying paper. Unlike hormone replacement therapy, prostate surgery is a "Rubicon" procedure -- that is, once undertaken it cannot be reversed. In the United States, a pilot study on the impact of a programme to aid in decisions about benign prostatic hyperplasia showed a 40% decrease in surgery rates. This finding was not replicated in a subsequent randomised controlled trial.
Posted in Patient Decision Aids, Patient Involvement, Special Populations
Tagged Angela Coulter, benign prostatic hyperplasia, BMJ, BPH, decision aids, decision making, men, multimedia, primary care, prostatectomy, Shared Decision-Making® programs, treatment decisions
Evidence based health care has become the accepted basis of good clinical practice, and many efforts are being made to implement it. Evidence based patient choice, defined as offerring patients research based information and the opportunity to influence decisions about their treatment and care, has yet to achieve the same status. We believe, however, that is is fundamental to high quality patient care.
Posted in Patient Decision Aids, Patient Involvement, SDM Implementation
Tagged Angela Coulter, BMJ, decision aids, decision making, doctor-patient communication, evidence-based medicine, health care, patient choice, patient empowerment, treatment decisions
Shared decision making, in which patients and health professionals join in both the process of decision making and ownership of the decision made, is attracting considerable interest as a means by which patients' preferences can be incorporated into clinical decisions. When there are several treatment options which may have different effects on the patient's quality of life, there is a strong case for offering patients choice. Their active involvement in decision making may increase the effectiveness of the treatment.
Posted in Decision Aid Components, Patient Decision Aids, Patient Involvement, Patient Preferences
Tagged Angela Coulter, BMJ, decision aids, decision making, patient-centered care, preference-sensitive care, shared decision making, treatment decisions
The traditional style of medical decision-making in which doctors take sole responsibility for treatment decisions is being challenged. Attempts are being made to promote shared decision-making in which patients are given the opportunity to express their values and preferences and to participate in decisions about their care. Critics of shared decision-making argue that most patients do not want to participate in decisions; that revealing the uncertainties inherent in medical care could be harmful; that it is not feasible to provide information about the potential risks and benefits of all treatment options; and that increasing patient involvement in decision-making will lead to greater demand for unnecessary, costly or harmful procedures which could undermine the equitable allocation of health care resources.
Posted in Patient Decision Aids, Patient Involvement, Patient Preferences
Tagged Angela Coulter, decision making, decision support, health care, informed decisions, patient engagement, patient participation, patients, shared decision making, treatment decisions
Our objective was to assess the acceptability of using an interactive video system in a general practice setting to inform patients about treatment choices. A descriptive cohort study was carried out in eight general practices in Oxfordshire. Fifty-four patients with mild hypertension and 29 with benign prostatic hypertrophy were studied. Patients' views of the video, treatment preference, level of involvement in treatment decision and satisfaction with decision-making process and GP's views of the effect of the video on subsequent consultations were measured.
Posted in Decision Aid Components, Decision Aid Effectiveness, Patient Decision Aids, Patient Involvement, SDM Implementation
Tagged Angela Coulter, benign prostatic hypertrophy, decision making, general practice, informed decisions, interactive videos, patients, treatment decisions, UK
With any surgery, consent must be obtained from each patient, and valid consent is based on knowledge of the options, the risks and benefits of each option, and the likelihood that these will occur for the individual patients. The legal doctrine and requirements of informed consent are well known. In theory, informed consent is a process, not a moment in time. In reality, it has occurred when a clinician requests a signature from a patient to authorize that a specific treatment or procedure take place, and the patient signs. In current practice, there is no requirement that shared decision-making occur before the signing of the consent form.
Posted in Patient Decision Aids, Patient Involvement, Patient Preferences, SDM Implementation
Tagged consent form, Dartmouth-Hitchcock Medical Center, decision aids, decision making, informed consent, informed decisions, informed patient choice, Medicare, patient-centered care, patients, shared decision making, surgery
Support for a model of shared medical decision making, where women and their care providers discuss risks and benefits of their different options, reveal their preferences, and jointly make a decision, is a growing expectation in obstetric care. The objective of this study was to conduct a systematic review and meta-analysis of randomized controlled trials evaluating the efficacy of different decision aid tools compared to regular care for women facing several option in the specific field of obstetric care. We included published studies about interventions designed to aid mothers' decision making and provide information about obstetrical treatment or screening options.
Posted in Patient Decision Aids, Patient Involvement, Patient Preferences, SDM in Maternity Care, Special Populations
Tagged childbirth, decision aids, decision making, decision support, doctor-patient communication, health education, informed consent, obstetrics, patient-centered care, pregnant women, shared decision making, women
Lee C, Belkora J, Chang Y, Moy B, Partridge A, Sepucha K. Are patients making high-quality decisions about breast reconstruction after mastectomy? Plast Reconstr Surg 2011 Jan; 127 (1): 18-26.
Variation in rates of breast reconstruction after mastectomy has raised concerns about the quality of decisions about reconstruction. The authors sought to evaluate patient decision making about reconstruction, using a validated measure of knowledge and preferences related to reconstruction.
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Sepucha K. Decision quality. in Encyclopedia of Medical Decision Making (ed. M. Kattan). Sage: London. 2009 Aug 15.
Decision making is a critical element in the field of medicine that can lead to life-or-death outcomes, yet it is an element fraught with complex and conflicting variables, diagnostic and therapeutic uncertainties, patient preferences and values, and costs. Broadly speaking, concepts in medical decision making (MDM) may be divided into two major categories: prescriptive and descriptive. Work in the area of prescriptive MDM investigates how medical decisions should be done using complicated analyses and algorithms to determine cost-effectiveness measures, prediction methods, and so on. In contrast, descriptive MDM studies how decisions actually are made involving human judgment, biases, social influences, patient factors, and so on. The Encyclopedia of Medical Decision Making gives a gentle introduction to both categories, revealing how medical and healthcare decisions are actually made—and constrained—and how physician, healthcare management, and patient decision making can be improved to optimize health outcomes. (Amazon)
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