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
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Available from: Alexander A Kon, Jan 23, 2015
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    • "It's hard to imagine an ethical argument against these principles, but one common misconception is that collaborating with patients creates the risk of their making decisions that are detrimental to their health and well-being[6]. But collaboration, by its very nature, means that patients and families don't make decisions in a vacuum, without the input of clinicians; shared decision making is a continuum[7], not an all-or-nothing proposition. We suggest that clinicians and health care organizations can apply Pine and Gilmore's prescription of creating an exceptional experience of care by partnering with patients and families to redesign care and can do so in a way that increases value by simultaneously improving clinical outcomes and decreasing costs. "

    Full-text · Article · Feb 2016
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    • "There are two general opinions regarding how SDM should be defined. One view is that SDM is a continuum of approaches that includes a broad range of models in which clinicians and patients and/or families share in decision making (Kon 2010). Data demonstrate that patient and family preferences for their own role in decision making and the role of the clinician vary significantly (Johnson et al. 2011;Madrigal et al. 2012). "

    Full-text · Article · Jan 2016 · The American Journal of Bioethics
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    • "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. "
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    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.
    Full-text · Article · Oct 2015 · Seminars in Fetal and Neonatal Medicine
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