The Shared Decision Making Continuum

Division of Pediatric Critical Care Medicine, and Clinical and Translational Science Center, University of California, Davis, Sacramento, CA 95817, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 08/2010; 304(8):903-4. DOI: 10.1001/jama.2010.1208
Source: PubMed
Download full-text


Available from: Alexander A Kon, Jan 23, 2015
  • Source
    • "Many patients want to decide in partnership with healthcare providers, and sometimes they prefer that physicians decide for them. During the last decade, shared decision-making has been considered to be the ideal doctorepatient relationship [5] [6]: physicians are expected to ask patients about their goals of care and their values, and then engage in deciding with them the intervention which most closely matches those goals. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The ethics of neonatal research are complex because vulnerable new parents are asked to provide consent on behalf of their fragile baby. Whereas clinical neonatal care has evolved to value personalized and shared decision-making, the goal of research ethics is still to standardize the informed consent process and make it as complete and thorough as possible. Ethicists, lawyers and physicians have shaped the field of research ethics and consent for research. The goal of detailed informed consent is to protect participants from harm, but procedures were developed without input from the principal stakeholders: ex-neonatal intensive care unit parents/patients. Empirical investigations examining patient and parental perspectives on research and research ethics are lacking. Rigorous investigations are needed to determine how parents of sick neonates want their families to be protected, knowing that a lack of research is also harmful. Large randomized controlled multicenter trials will always be needed to improve neonatal outcomes. These trials are costly and time-consuming. Currently, the way in which research is funded and regulated and the way in which academic merit is recognized lead to inefficiency and a waste of precious resources. Following a review of the history of research ethics, this article examines and discusses the ethics of research in neonatology. In addition, challenges and opportunities are identified and ideas for future investigations are proposed.
    Seminars in Fetal and Neonatal Medicine 10/2015; DOI:10.1016/j.siny.2015.10.003 · 3.03 Impact Factor
    • "Over the past three decades, there has been gradual movement towards reform of the doctorpatient relationship from one designed to sustain doctors' professional autonomy and benign paternalism (Kaufmann, 1983), to one promoting patient autonomy and shared decision-making (Kon, 2010). The Western philosophical belief of 'autonomy' or self-determination emphasises respect for individuals' rights to control their lives and actions by their own choices, 'at least to the greatest extent compatible with the rights of others' (Herbert, 1980, p. 1042). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Standards expected by doctors' regulatory bodies in respect of the process of consent to treatment have arguably sought to restructure the nature of the doctor-patient relationship from one of the paternalism to that of shared decision-making. Yet, few studies have explored empirically, from patients' perspectives, the extent to which the process of consent to treatment enables or disables patients' participation in medical decision-making. Our article examines patients' attitudes towards the consent process, exploring how and why these attitudes influence patients' active participation in decision-making and considering possible consequent medico-legal issues. Data were collected longitudinally using semi-structured interviews and field observations involving 35 patients and 19 of their caregivers, in an English hospital between February and November 2014. These indicate that generally patients defer to the doctor in respect of treatment decision-making. Although most patients and their caregivers wanted detailed information and discussion, they did not necessarily expect that this would be provided. Furthermore, patients perceived that signing the consent form was an obligatory routine principally to protect doctors from legal action should something go wrong. Our study suggests that patients' predominantly paternalistic perceptions of the consent process can not only undermine attempts by doctors to involve them in decision-making but, as patients are now considered in law as informed actors, their perceptions of the consent form as not being in their interests could be a self-fulfilling prophecy if signing is undertaken without due consideration to the content.
    Health 10/2015; DOI:10.1177/1363459315611870 · 2.10 Impact Factor
  • Source
    • "Cancer treatment decisions are rather complex, because they are embedded in a social context; individuals with cancer have relatives, friends, and a team of providers who work with them in some capacity to arrive at decisions about whether and how to treat their cancer. Indeed, physicians are now encouraged to participate in shared decision making, where they partner with patients in facilitating an informed choice (Kon, 2010). Although we know that emotional experiences can be transmitted or shared (e.g., De Vignemont & Singer, 2006), much remains to be learned about mechanisms and consequences of this phenomenon in the context of complex social relationships or networks. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Cancer control research involves the conduct of basic and applied behavioral and social sciences to reduce cancer incidence, morbidity, and mortality and improve quality of life. Given the importance of behavior in cancer control, fundamental research is necessary to identify psychological mechanisms underlying cancer risk, prevention, and management behaviors. Cancer prevention, diagnosis, and treatment are often emotionally laden. As such, affective science research to elucidate questions related to the basic phenomenological nature of emotion, stress, and mood is necessary to understand how cancer control can be hindered or facilitated by emotional experiences. To date, the intersection of basic affective science research and cancer control remains largely unexplored. The goal of this article is to outline key questions in the cancer control research domain that provide an ecologically valid context for new affective science discoveries. We also provide examples of ways in which basic affective discoveries could inform future cancer prevention and control research. These examples are not meant to be exhaustive or prescriptive but instead are offered to generate creative thought about the promise of a cancer research context for answering basic affective science questions. Together, these examples provide a compelling argument for fostering collaborations between affective and cancer control scientists. © The Author(s) 2015.
    Perspectives on Psychological Science 05/2015; 10(3):328-45. DOI:10.1177/1745691615576755 · 4.89 Impact Factor
Show more