Shared decision making: Concepts, evidence, and practice☆
Section snippets
Background
Shared decision making (SDM) is increasingly advocated as the preferred model to engage patients in the process of deciding about diagnosis, treatment or follow-up when more than one medically reasonable option is available. The phrase “sharing of decision making” was used for the first time in 1972 by Veatch [1], in his paper “Models for Ethical Medicine in a Revolutionary Age: What physician-patient roles foster the most ethical relationship?” Yet, the concept SDM started did not appear in
Ethics
The first and most obvious line of thinking that leads people to advocate SDM arose in ethics. In 1972, Veatch discussed four models of the professional-lay relationship in the context of ensuring people's right to health care [1]. Following both the biological revolution (‘cure of disease is possible’) and the social revolution (‘all men are to be treated equally’), healthcare had become “a human right, no longer a privilege limited to those who can afford it” (p. 5). Veatch pleaded for a
Shared decision making: concepts and definitions
Thus, SDM had been put on the agenda via two different fields, medical ethics and health services research. The major breakthrough came with two papers by Charles and colleagues [2], [19] that tried to elucidate the concept, “(…) for it is by no means clear what shared decision making really means or the criteria by which to judge what falls within or outside the boundaries of this model.” [2] They described an important aspect that distinguishes SDM from previous models of treatment decision
Are the four SDM steps implemented in clinical practice?
To date little evidence is available on the effects of SDM on patient outcomes, particularly health outcomes [22]. One reason for this absence of evidence is the lack of good measurement instruments, particularly to assess the actual realization of SDM [23], [24]. Research on methods to assess SDM appeared relatively late. It showed that there is little agreement between patient-, professional-, and observer-based reports on the occurrence of SDM [25]. Earlier studies had mostly used the SDM-Q
Shared decision making: elaboration of the steps and communication propositions
Clinicians may think that the process described below is lengthy. Indeed, the evidence so far shows a small increase in consultation time if time is invested in SDM [15], [42]. Yet, if taken carefully, the steps may lead not only to decisions that better fit the individual patient and as a result provide more satisfaction, but also to better professional-patient relations, fewer repeat consultations, fewer requests for second opinions, and, in the long term better treatment adherence and
Discussion
In 2015, over 40 years after the first mentioning of the term SDM, and over 15 years after Charles et al.’s publications, SDM has finally reached the implementation agenda and become the target of educational programs in many countries around the world. Yet, there is still little evidence for its occurrence in clinical practice. Therefore, there is on-going debate on how to improve implementation, through training and tools, both for professionals and patients [62], [63]. A number of
Conflicts of interest
No conflicts of interest declared.
Author’s contribution
All authors have individually contributed to the article: in drafting the article and revising it critically for important intellectual content and have approved the final version submitted.
Acknowledgements
We would like to thank Marleen Kunneman for proof-reading of the paper, and two anonymous reviewers for their helpful suggestions.
References (75)
- et al.
Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango)
Soc. Sci. Med.
(1997) - et al.
An integrative model of shared decision making in medical encounters
Patient Educ. Couns.
(2006) Forty years of unwarranted variation–and still counting
Health Policy
(2014)- et al.
Professional uncertainty and the problem of supplier-induced demand
Soc. Sci. Med.
(1982) - et al.
Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model
Soc. Sci. Med.
(1999) - et al.
Measurement of shared decision making—a review of instruments
Z. Evid. Fortbild. Qual. Gesundhwes.
(2011) - et al.
Development and psychometric properties of the shared decision making questionnaire–physician version (SDM-Q-Doc)
Patient Educ. Couns.
(2012) - et al.
The 9-item shared decision making questionnaire (SDM-Q-9) development and psychometric properties in a primary care sample
Patient Educ. Couns.
(2010) - et al.
Completing the third person’s perspective on patients' involvement in medical decision-making: approaching the full picture
Z. Evid. Fortbild. Qual. Gesundhwes.
(2012) - et al.
Physician as partner or salesman? Shared decision-making in real-time encounters
Soc. Sci. Med.
(2009)
Information communicated with patients in decision making about their abdominal aortic aneurysm
Eur. J. Vasc. Endovasc. Surg.
Optimal matches of patient preferences for information, decision-making and interpersonal behavior: evidence, models and interventions
Patient Educ. Couns.
Endometrial cancer survivors are unsatisfied with received information about diagnosis, treatment and follow-up: a study from the population-based PROFILES registry
Patient Educ. Couns.
Shared decision making: prostate cancer patients’ appraisal of treatment alternatives and oncologists' eliciting and responding behavior, an explorative study
Patient Educ. Couns.
Theory-informed design of values clarification methods: a cognitive psychological perspective on patient health-related decision making
Soc. Sci. Med.
Option Grids shared decision making made easier
Patient Educ Couns.
Patients' preference for involvement in medical decision making: a narrative review
Patient Educ. Couns.
Do prostate cancer patients want to choose their own radiation treatment
Int. J. Radiat. Oncol. Biol. Phys.
Three questions that patients can ask to improve the quality of information physicians give about treatment options: A cross-over trial
Patient Educ. Couns.
GRADE guidelines: 14. Going from evidence to recommendations: the significance and presentation of recommendations
J. Clin. Epidemiol.
Clinical practice guidelines and patient decision aids. An inevitable relationship
J. Clin. Epidemiol.
Models for ethical medicine in a revolutionary age. What physician-patient roles foster the most ethical relationship?
Hastings Cent. Rep.
Clinician and cancer patient views on patient participation in treatment decision-making: a quantitative and qualitative exploration
Br. J. Cancer
Preoperative risk information and patient involvement in surgical treatment for rectal and sigmoid cancer
Colorectal Dis.
Assessments of the extent to which health-care providers involve patients in decision making: a systematic review of studies using the OPTION instrument
Health Expect.
Reason for encounter: a missed opportunity for shared decision making
Med. Decis. Making
Shared decision making: really putting patients at the centre of health care
Br. Med. J.
Principles of Biomedical Ethics
Four models of the physician-patient relationship
J. Am. Med. Assoc.
Risk communication in practice: the contribution of decision aids
Br. Med. J.
Dealing with medical practice variations: a proposal for action
Health Aff.
Decision aids for people facing health treatment or screening decisions
Cochrane Database Syst. Rev.
Shared decision making to improve care and reduce costs
N. Engl. J. Med.
Undetermined impact of patient decision support interventions on healthcare costs and savings: systematic review
Br. Med. J.
The value of sharing treatment decision making with patients: expecting too much
J. Am. Med. Assoc.
Shared decision making in the medical encounter: are we all talking about the same thing
Med. Decis. Making.
Shared decision making: a model for clinical practice
J. Gen. Intern. Med.
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Paper presented at the Annual Meeting of the European Association for Communication in Health, Amsterdam September 2014