Article

Framework for teaching and learning informed shared decision making

Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada V5Z 4E3.
BMJ Clinical Research (Impact Factor: 14.09). 10/1999; 319(7212):766-71.
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Available from: William Godolphin, Jul 29, 2015
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    • "But other definitions exist (e.g. [3] [10]) and the most common way of measuring patient perceptions of SDM is using a modification of the Degner et al. Control Preferences Scale [11] [12]. "
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    ABSTRACT: Objective This study aims to develop a conceptual model of patient-defined SDM, and understand what leads patients to label a specific, decision-making process as shared. Methods Qualitative interviews were conducted with 23 primary care patients following a recent appointment. Patients were asked about the meaning of SDM and about specific decisions that they labeled as shared. Interviews were coded using qualitative content analysis. Results Patients’ conceptual definition of SDM included four components of an interactive exchange prior to making the decision: both doctor and patient share information, both are open-minded and respectful, patient self-advocacy, and a personalized physician recommendation. Additionally, a long-term trusting relationship helps foster SDM. In contrast, when asked about a specific decision labeled as shared, patients described a range of interactions with the only commonality being that the two parties came to a mutually agreed-upon decision. Conclusion There is no one-size-fits all process that leads patients to label a decision as shared. Rather, the outcome of “agreement” may be more important than the actual decision-making process for patients to label a decision as shared. Practice Implications Studies are needed to better understand how longitudinal communication between patient and physicians and patient self-advocacy behaviors affect patient perceptions of SDM.
    Patient Education and Counseling 09/2014; 96(3). DOI:10.1016/j.pec.2014.07.017 · 2.60 Impact Factor
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    • "Such disagreement may surface when there is no unambiguous evidence about the best treatment option or when doctor and patient disagree about the implications of a certain treatment method. " Physician and patient are then in conflict, and a solution needs to be negotiated " (Towle & Godolphin, 1999, p. 768). Promoting a decision-making process in which doctor and patient aim to build consensus about the appropriate Downloaded by [University of Lugano] at 04:35 03 January 2014 treatment to implement and coequally negotiate a resolution to any disagreement that arises during consultation, shared decision making constitutes more than explicitly engaging in a dialogue. "
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    ABSTRACT: In view of a growing interest in argumentative discourse in the context of patient-centered consultation and shared decision making, this article explores the role that argumentation has been attributed in the literature on doctor-patient consultation so far. It studies to what extent theories and concepts of argumentation have been applied by scholars from various fields in order to analyze, understand, facilitate, and improve the argumentative nature of medical consultation. It reports on an extensive and systematic literature search-using eight online databases, expert suggestions, and a manual search-and the subsequent evaluation of 1,330 abstracts on the basis of strict inclusion and exclusion criteria. Forty relevant scientific contributions are grouped into four main categories and discussed accordingly: (a) argumentation theory, (b) discourse analysis, (c) medical informatics, and (d) medical ethics. Because of its systematic approach, this study forms a solid starting point for further integration of argumentation theoretical insights into contemporary views of patient-centered medicine and evidence-based medicine. It provides suggestions for further interdisciplinary and theory-driven research with a strong focus on empirical reality. Doing so, a preliminary model is proposed that outlines the potential effects of the quality of doctors' communication on proximal, intermediate, and long-term consultation outcomes.
    Health Communication 12/2013; 29(10). DOI:10.1080/10410236.2013.829018 · 0.97 Impact Factor
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    • "The literature to date suggests that women taking lithium can be supported to breastfeed their infants. Ideally, a shared decision-making approach (Towle and Godolphin 1999) would be used. Employing this model requires the physician to develop a partnership with the mother, determine her preferences for infant feeding, respond to her concerns and evaluate the evidence in relation to her situation (including providing information regarding risks and benefits of formula and breastfeeding), negotiate a decision, and agree on a maternal and infant monitoring plan. "
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    ABSTRACT: The aim of this study was to provide data to aid decision making regarding lithium use during lactation. Three women treated with lithium for bipolar disorder during pregnancy and lactation and their four infants provided lithium levels at 1 month postpartum. Infant levels ranged from 10% to 17% of maternal levels. Two infants experienced early feeding problems which were overcome with breastfeeding education and support. Women taking lithium can be supported to breastfeed, and their infants should be followed closely until breastfeeding is well established.
    Archives of Women s Mental Health 02/2012; 15(1):69-72. DOI:10.1007/s00737-012-0257-3 · 1.96 Impact Factor
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