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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    • "Physicians have limited training and suboptimal ability to adequately assess screening benefit and overdiagnosis [18] . They should be provided with absolute measures of the risk reduction expected from screening, framed in an easy to understand manner, and aimed at sharing the screening decision with their patients [19]. Increasing awareness of health professionals and patients about overdiagnosis should contribute to fight against pressure to prescribe popular but inefficient screening tests and, to some extent, against financial incentives from diagnostic and pharmaceutical industries to perform them [20, 21]. "
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    ABSTRACT: Overdiagnosis is the diagnosis of an abnormality that bears no substantial health hazard and no benefit for patients to be aware of. Resulting mainly from the use of increasingly sensitive screening and diagnostic tests, as well as broadened definitions of conditions requiring an intervention, overdiagnosis is a growing but still largely misunderstood public health issue. Fear of missing a diagnosis or of litigation, financial incentives or patient’s need of reassurance are further causes of overdiagnosis. The main consequence of overdiagnosis is overtreatment. Treating an overdiagnosed condition bears no benefit but can cause harms and generates costs. Overtreatment also diverts health professionals from caring for those most severely ill. Recognition of overdiagnosis due to screening is challenging since it is rarely identifiable at the individual level and difficult to quantify precisely at the population level. Overdiagnosis exists even for screening of proven efficacy and efficiency. Measures to reduce overdiagnosis due to screening include heightened sensitization of health professionals and patients, active surveillance and deferred treatment until early signs of disease progression and prognosis estimation through biomarkers (including molecular) profiling. Targeted screening and balanced information on its risk and benefits would also help limit overdiagnosis. Research is needed to assess the public health burden and implications of overdiagnosis due to screening activity.
    Preview · Article · Dec 2015
    • "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). "
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    ABSTRACT: A randomised controlled trial (RCT) has demonstrated that the Shared Decision-Making (SDM) intervention Deciding Together is an effective way to reach and evaluate a treatment agreement in addiction health care and results in reduction of psychiatric problems and severity of drug use. The way in which the RCT was performed cannot be adopted into clinical practice immediately. This article discusses results of an implementation project. Implementation was not hampered by the intervention itself but proceeds slowly owing to current developments within mental health care. On the other hand, there is significant importance and interest in the studied SDM intervention.
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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.
    Full-text · Article · Sep 2015 · Patient Education and Counseling
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