Shared decision-making in medicine

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Contents

Last Update

This entry is out of date, and will not be updated, June 2017

Introduction

See also Bibliotherapy | Diagnostic error prevention & patient safety | Evidence-based health care | Health 2.0 | Information prescriptions | MedlinePlus (U.S.) | Patient education

"... shared decision-making (SDM) between physician and patient is an idea founded in ethics and the law and in some evidence of superior health outcomes. SDM is the practical reconciliation of respect for persons (autonomy) and the monopoly and power of physicians: a middle ground between "nanny-knows-best" paternalism and rampant consumerism..." — Godolphin, 2009

Shared decision-making in medicine as opposed to physicians making decisions on behalf of their patients is gaining more and more prominence in health care. Shared decision-making (SDM) has been defined as: "an approach where clinicians and patients share the best available evidence when faced with the task of making decisions, and where patients are supported to consider options, to achieve informed preferences". There is evidence to show that patients are not as closely involved with their physicians in making decisions as they should be. One strategy for doing so is increasing the opportunities for collaboration between the health professionals and patients through two-way communication and information exchange.

Shared decision-making process

Patient engagement models.png

Any shared (or informed) decision relies heavily on two-way communication. In medicine, typically, this means helping patients to:

  • recognize that a decision needs to be made
  • know about available options and associated procedures, benefits, harms, probabilities, and scientific uncertainties
  • understand that values affect decisions
  • be clear about which features of the options matter most to them (e.g. benefits, harms, and scientific uncertainties)
  • discuss values with their clinician(s); and
  • become involved in decision making in ways they prefer

The library's traditional role of providing basic information to patients has been transformed into delivering comprehensive information when needed, including high-level expert or advanced information. It makes sense that libraries should promote this form of patient education within hospitals, and to involve health librarians in those efforts.

What makes a good decision?

Decisions that are based on the preferences of the patient are more likely to be considered good decisions, especially in retrospect. When decisions reflect the preferences, values and needs of patients and their caregivers, the result is shared decision-making. Informed choice is also a part of the equation, and part of a movement known as evidence-based health care. EBHC is aimed at helping health professionals make the best health care-related decisions based on the best evidence currently available.

Information is key

The basic purpose of SDM is to foster more informed decision-making for patients and their caregivers. This involves improving patients' understanding of risks and benefits of available treatments, improving the comprehension of probability information about diseases and treatments, creating realistic expectations about the consequences of treatment options and improving clarity about personal values. To achieve these goals, information must be presented in a complete and neutral manner. When information is incomplete, patients may find that they overvalue or undervalue a treatment option. However, when information is presented in a non-neutral manner, it may stimulate a cognitive bias that can unduly affect someone's preference. The effect in turn may undermine a decision aid. In the literature, there is some debate about whether decision aids ought to encourage patients towards any one option for which there is clear and strong evidence of a beneficial outcome.

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