Shared decision making: Really putting patients at the centre of healthcare

Department of Medical Decision Making, Leiden University Medical Centre, Netherlands.
BMJ (online) (Impact Factor: 17.45). 01/2012; 344(jan27 1):e256. DOI: 10.1136/bmj.e256
Source: PubMed


Although many clinicians feel they already use shared decision making, research shows a perception-reality gap. A M Stiggelbout and colleagues discuss why it is important and highlight some best practices.

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Available from: Lyndal Trevena, Sep 30, 2015
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    • "Thus, the steps to be taken in SDM are seen to a limited extent only in daily clinical practice. We explain these steps in more detail in the next section and, to facilitate their use, suggest phrases that may be used in each step to support the SDM process in separate boxes [8] "
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    ABSTRACT: Objective: Shared decision-making (SDM) is advocated as the model for decision-making in preference-sensitive decisions. In this paper we sketch the history of the concept of SDM, evidence on the occurrence of the steps in daily practice, and provide a clinical audience with communication strategies to support the steps involved. Finally, we discuss ways to improve the implementation of SDM. Results: The plea for SDM originated almost simultaneously in medical ethics and health services research. Four steps can be distinguished: (1) the professional informs the patient that a decision is to be made and that the patient's opinion is important; (2) the professional explains the options and their pros and cons; (3) the professional and the patient discuss the patient's preferences and the professional supports the patient in deliberation; (4) the professional and patient discuss the patient's wish to make the decision, they make or defer the decision, and discuss follow-up. In practice these steps are seen to occur to a limited extent. Discussion: Knowledge and awareness among both professionals and patients as well as tools and skills training are needed for SDM to become widely implemented. Practice implications: Professionals may use the steps and accompanying communication strategies to implement SDM.
    Patient Education and Counseling 09/2015; 98(10):1172-9. DOI:10.1016/j.pec.2015.06.022 · 2.20 Impact Factor
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    • "Founded on an ethical imperative [2], and consonant with the demands of an increasingly informed population [3], it now represents the dominating principle underlying medical communication curricula in Western societies [4]. One important feature of patientcentred medicine is the involvement of patients in decisions about treatment (shared decision making (SDM)) [5] [6] [7] [8] [9] [10]. Patient-centred medicine and SDM have been embraced politically [11], and in Norway, the Law on patients' rights mandates these principles [12]. "
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    ABSTRACT: Objective To explore how physician efforts to involve patients in medical decisions align with established core elements of shared decision making (SDM). Methods Detailed video analysis of two hospital outpatient encounters, selected because the physicians exhibited much effort to involve the patients in decision making, and because the final decisions were not what the physicians had initially recommended. The analysis was supplied by physician, patient, and observer-rated data from a total of 497 encounters collected during the same original study. The observer-rated data confirmed that these physicians demonstrated above average patient-centred skills in this material. Results Behaviors of these two not trained physicians demonstrated confusion about how to perform SDM. Information provided to the patients was imprecise and ambiguous. Insufficient patient involvement did not prompt the physicians to change strategy. Physician and patient reports indicated awareness of suboptimal communication. Co***nclusion Inadequate SDM in hospital encounters may introduce confusion. Quantitative evaluations by patients and observers may reflect much effort rather than process quality. Practice implications SDM may be discredited because the medical community has not acquired the necessary skills to perform it, even if it is ethically and legally mandated. Training and supervision should follow regulations and guidelines.
    Patient Education and Counseling 09/2014; 96(3). DOI:10.1016/j.pec.2014.07.012 · 2.20 Impact Factor
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    • "The growth in SDM publications found in our study nevertheless supports the call of experts in the field for the medical community to implement SDM in practice [2,3,44,45]. Some of these calls have been published in major medical journals. "
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    ABSTRACT: Background Shared Decision Making (SDM) is increasingly advocated as a model for medical decision making. However, there is still low use of SDM in clinical practice. High impact factor journals might represent an efficient way for its dissemination. We aimed to identify and characterize publication trends of SDM in 15 high impact medical journals. Methods We selected the 15 general and internal medicine journals with the highest impact factor publishing original articles, letters and editorials. We retrieved publications from 1996 to 2011 through the full-text search function on each journal website and abstracted bibliometric data. We included publications of any type containing the phrase “shared decision making” or five other variants in their abstract or full text. These were referred to as SDM publications. A polynomial Poisson regression model with logarithmic link function was used to assess the evolution across the period of the number of SDM publications according to publication characteristics. Results We identified 1285 SDM publications out of 229,179 publications in 15 journals from 1996 to 2011. The absolute number of SDM publications by journal ranged from 2 to 273 over 16 years. SDM publications increased both in absolute and relative numbers per year, from 46 (0.32% relative to all publications from the 15 journals) in 1996 to 165 (1.17%) in 2011. This growth was exponential (P < 0.01). We found fewer research publications (465, 36.2% of all SDM publications) than non-research publications, which included non-systematic reviews, letters, and editorials. The increase of research publications across time was linear. Full-text search retrieved ten times more SDM publications than a similar PubMed search (1285 vs. 119 respectively). Conclusion This review in full-text showed that SDM publications increased exponentially in major medical journals from 1996 to 2011. This growth might reflect an increased dissemination of the SDM concept to the medical community.
    BMC Medical Informatics and Decision Making 08/2014; 14(1):71. DOI:10.1186/1472-6947-14-71 · 1.83 Impact Factor
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