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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    • "Het bleek dat 48 % van de klinische en 30 % van de eerstelijnscliënten meer betrokken hadden willen worden bij beslissingen over hun behandeling (Elwyn et al. 2010). De verwachting is dat de implementatie van SDM in de gezondheidzorg complex zal zijn (Gravel et al. 2006; Légaré et al. 2008), onder meer doordat het een cultuurverandering vraagt van hulpverlener, organisatie en cliënt (Stiggelbout et al. 2012). Voor de meestgenoemde barrière, de grote tijdsinvestering, blijkt er echter geen duidelijk bewijs te zijn (Légaré et al. 2008). "

    Verslaving 11/2015; DOI:10.1007/s12501-015-0042-x
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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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