Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango)

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Abstract

Shared decision-making is increasingly advocated as an ideal model of treatment decision-making in the medical encounter. To date, the concept has been rather poorly and loosely defined. This paper attempts to provide greater conceptual clarity about shared treatment decision-making, identify some key characteristics of this model, and discuss measurement issues. The particular decision-making context that we focus on is potentially life threatening illnesses, where there are important decisions to be made at key points in the disease process, and several treatment options exist with different possible outcomes and substantial uncertainty. We suggest as key characteristics of shared decision-making (1) that at least two participantsā€”physician and patient be involved; (2) that both parties share information; (3) that both parties take steps to build a consensus about the preferred treatment; and (4) that an agreement is reached on the treatment to implement. Some challenges to measuring shared decision-making are discussed as well as potential benefits of a shared decision-making model for both physicians and patients.

References (63)

  • A.E Beisecker et al.

    Patient informationā€”seeking behaviors when communicating with doctors

    Medical Care

    (1990)
  • F.C Biley

    Some determinants that effect patient participation in decision-making about nursing care

    Journal of Advanced Nursing

    (1992)
  • D.W Brock et al.

    When competent patients make irrational choices

    New England Journal of Medicine

    (1990)
  • D.S Brody et al.

    Patient perception of involvement in medical care: relationship to illness attitudes and outcomes

    Journal of General Internal Medicine

    (1989)
  • D.S Brody

    The patient's role in clinical decision making

    Annals of Internal Medicine

    (1980)
  • B Cassileth et al.

    Information and participation preferences among cancer patients

    Annals of Internal Medicine

    (1980)
  • C Charles et al.

    Lay participation in health care decision-making: a conceptual framework

    Journal of Health Politics, Policy and Law

    (1993)
  • R.M Coe et al.

    The formation of coalitions: Interaction strategies in triads

    Sociology of Health and Illness

    (1985)
  • R Deber

    Physicians in health care management: 7. The patient-physician partnership: Changing roles and the desire for information

    Canadian Medical Association

    (1994)
  • D.M Eddy

    Anatomy of a decision

    Journal of the American Medical Association

    (1990)
  • L.D Egbert et al.

    Reduction of postoperative pain by encouragement and instruction of patients

    New England Journal of Medicine

    (1964)
  • E.J Emanuel et al.

    Four models of the physician-patient relationship

    Journal of the American Medical Association

    (1992)
  • J Ende et al.

    Measuring patients' desire for autonomy: decision making and information seeking preferences among medical patients

    Journal of General Internal Medicine

    (1989)
  • J.R Evans

    Toward a shared direction for health in Ontario

  • R.G Evans

    Strained Mercy: The Economics of Canadian Health Care

    (1984)
  • E Freidson

    Professional Dominance

    (1970)
  • R.E Gray et al.

    Empowerment and persons with cancer: Politics in cancer medicine

    Journal of Palliative Care

    (1990)
  • B Greene

    Breast Cancer: Unanswered Questions

  • S Greenfield et al.

    Expanding patient involvement in care: effects on patient outcomes

    Annals of Internal Medicine

    (1985)
  • S Greenfield et al.

    Patients' participation in medical care: effects on blood sugar control and quality of life in diabetes

    Journal of General Internal Medicine

    (1988)
  • M.R Haug et al.

    Practitioner or patient: Whose in charge?

    Journal of Health and Social Behavior

    (1981)
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