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Shared decision making is a concept in medical care where doctors explain treatments and alternatives to patients, and patients choose the course of action most in keeping with their unique personal and cultural preferences.  This is in contrast with the [[paternalistic model]] of medical decision making, where up until the 1990s, doctors told patients what to do, and the patients unquestioningly obeyed<ref>{{cite journal |author=Buchanan A |title=Medical paternalism |journal=Philos Public Aff |volume=7 |issue=4 |pages=370-90 |year=1978 |pmid=11664929}}</ref>.  Cultural events such as the 1990 [[Cruzan v. Director, Missouri Department of Health]] [[Supreme Court]] case and the 1976 case of [[Karen Ann Quinlan]] have strengthened patient [[autonomy]] as a critical component of [[medical ethics]], and shared decision making stems from giving patients more say in medical decisions.
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Shared decision making combines evidence-based medicine with the preferences of patients.
'''Patient participation''', also called '''shared decision making''', is  "patient involvement in the decision-making process in matters pertaining to health".<ref>{{MeSH|Patient participation}}</ref>
Usually health care providers explain treatments and alternatives to patients so that patients choose the course of action most consistent with their unique personal and cultural preferences. This concept may be contrasted with the [[paternalistic model]] of medical decision making, which was prevalent until the 1990s, in which doctors told patients what to do, and the patients unquestioningly obeyed<ref>{{cite journal |author=Buchanan A |title=Medical paternalism |journal=Philos Public Aff |volume=7 |issue=4 |pages=370-90 |year=1978 |pmid=11664929}}</ref>.
 
Shared decision making combines [[evidence-based medicine]] with the preferences of patients.Many medical decisions are not strictly based on science.  Patients have values that emphasize risks and benefits differently from their doctor.  There is frequently more than one correct decision.  Emerging importance of patient autonomy.  Recognition of informed consent as an important component of decision making.  Risk-benefit calculation renders not a single absolute recommendation but an assessment of outcome with more or less statistical certainty behind it.


Shared decision making emphasizes the importance of communication in the process of making a decision.
Shared decision making emphasizes the importance of communication in the process of making a decision.
==Rationale for shared decision-making==


Many medical decisions are not strictly based on science.  Patients have values that emphasize risks and benefits differently from their doctor.  Many times, there is not only one correct decision.  Emerging importance of patient autonomy.  Recognition of informed consent as an important component of decision making.  Risk-benefit calculation renders not a single absolute recommendation but an assessment of outcome with more or less statistical certainty behind it.
Shared decision making should be contrasted with [[informed consent]], and simple consent.<ref name="pmid14706973">{{cite journal |author=Whitney SN, McGuire AL, McCullough LB |title=A typology of shared decision making, informed consent, and simple consent |journal=Ann. Intern. Med. |volume=140 |issue=1 |pages=54–9 |year=2004 |pmid=14706973 |doi=}}</ref>
 
==Legal rationale==
Court cases such as the 1990 [[Cruzan v. Director, Missouri Department of Health]] [[Supreme Court]] case and the 1976 case of [[Karen Ann Quinlan]] have increased the importance of patient [[autonomy]] in [[medical ethics]]; shared decision making entails giving patients more influence in medical decisions.
 
==Methods==
===Using computers to interact with patients===
Internet websites may improve [[health behavior]] according to a [[randomized controlled trial]].<ref name="pmid21421955">{{cite journal| author=Hughes SL, Seymour RB, Campbell RT, Shaw JW, Fabiyi C, Sokas R| title=Comparison of two health-promotion programs for older workers. | journal=Am J Public Health | year= 2011 | volume= 101 | issue= 5 | pages= 883-90 | pmid=21421955 | doi=10.2105/AJPH.2010.300082 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21421955 }} </ref>
 
Internet websites for [[health promotion]] may improve [[health behavior]] according to a [[randomized controlled trial]].<ref name="pmid21421955">{{cite journal| author=Hughes SL, Seymour RB, Campbell RT, Shaw JW, Fabiyi C, Sokas R| title=Comparison of two health-promotion programs for older workers. | journal=Am J Public Health | year= 2011 | volume= 101 | issue= 5 | pages= 883-90 | pmid=21421955 | doi=10.2105/AJPH.2010.300082 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21421955 }} </ref>
 
Interactive software or Internet websites can help interact with the patient.<ref>Frosch, D. L., Bhatnagar, V., Tally, S., Hamori, C. J., & Kaplan, R. M. (2008). [http://archinte.ama-assn.org/cgi/content/full/168/4/363 Internet patient decision support: a randomized controlled trial comparing alternative approaches for men considering prostate cancer screening], Arch Intern Med, 168(4), 363-369. doi: 10.1001/archinternmed.2007.111.</ref><ref name="pmid11790064">{{cite journal |author=Barry MJ |title=Health decision aids to facilitate shared decision making in office practice |journal=Ann. Intern. Med. |volume=136 |issue=2 |pages=127–35 |year=2002 |pmid=11790064 |doi=}}</ref><ref>{{Cite journal
| doi = 10.1001/archinternmed.2007.109 | volume = 168| issue = 5| pages = 530-536| last = Kypri
| first = Kypros| coauthors = John D. Langley, John B. Saunders, Martine L. Cashell-Smith, Peter Herbison| title = Randomized Controlled Trial of Web-Based Alcohol Screening and Brief Intervention in Primary Care| journal = Arch Intern Med| accessdate = 2008-03-11| date = 2008-03-10| url = http://archinte.ama-assn.org/cgi/content/abstract/168/5/530
}}</ref> In some studies, Internet-based interventions improve upon usual care<ref>{{Cite journal
| doi = 10.1001/jama.299.24.2857 | volume = 299 | issue = 24 | pages = 2857-2867 | last = Green | first = Beverly B.
| coauthors = Andrea J. Cook, James D. Ralston, Paul A. Fishman, Sheryl L. Catz, James Carlson, David Carrell, Lynda Tyll, Eric B. Larson, Robert S. Thompson | title = Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial | journal = JAMA
| accessdate = 2008-06-25 | date = 2008-06-25 | url = http://jama.ama-assn.org/cgi/content/abstract/299/24/2857
}}</ref> whereas in other studies interpersonal interventions are better.<ref name="pmid18334689">{{cite journal |author=Svetkey LP, Stevens VJ, Brantley PJ, ''et al'' |title=Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial |journal=JAMA |volume=299 |issue=10 |pages=1139-48 |year=2008 |pmid=18334689 |doi=10.1001/jama.299.10.1139 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=18334689 |issn=}}</ref>
   
 
The quality of online decision aids is uncertain.<ref name="pmid18188653">{{cite journal |author=Levy AG, Sonnad SS, Kurichi JE, Sherman M, Armstrong K |title=Making sense of cancer risk calculators on the web |journal=J Gen Intern Med |volume=23 |issue=3 |pages=229-35 |year=2008 |pmid=18188653 |doi=10.1007/s11606-007-0484-x |url=http://dx.doi.org/10.1007/s11606-007-0484-x |issn=}}</ref>
 
===Shared decision making===
Patient-centered strategies such as the patient choosing options may increase compliance.<ref name="pmid24935273">{{cite journal| author=Wong MC, Ching JY, Chan VC, Lam TY, Luk AK, Ng SC et al.| title=Informed choice vs. no choice in colorectal cancer screening tests: a prospective cohort study in real-life screening practice. | journal=Am J Gastroenterol | year= 2014 | volume= 109 | issue= 7 | pages= 1072-9 | pmid=24935273 | doi=10.1038/ajg.2014.136 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24935273 }} </ref><ref name="pmid23189924">{{cite journal| author=Patel MR, Valerio MA, Janevic MR, Gong ZM, Sanders G, Thomas LJ et al.| title=Long-term effects of negotiated treatment plans on self-management behaviors and satisfaction with care among women with asthma. | journal=J Asthma | year= 2013 | volume= 50 | issue= 1 | pages= 82-9 | pmid=23189924 | doi=10.3109/02770903.2012.743151 | pmc=PMC3617926 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23189924  }} </ref><ref name="pmid20019345">{{cite journal| author=Wilson SR, Strub P, Buist AS, Knowles SB, Lavori PW, Lapidus J et al.| title=Shared treatment decision making improves adherence and outcomes in poorly controlled asthma. | journal=Am J Respir Crit Care Med | year= 2010 | volume= 181 | issue= 6 | pages= 566-77 | pmid=20019345 | doi=10.1164/rccm.200906-0907OC | pmc=PMC2841026 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20019345 }} </ref><ref name="pmid20398129">{{cite journal| author=Gerber JB, Bloom PA, Ross JS| title=The physical activity contract--tailored to promote physical activity in a geriatric outpatient setting: a pilot study. | journal=J Am Geriatr Soc | year= 2010 | volume= 58 | issue= 3 | pages= 604-6 | pmid=20398129 | doi=10.1111/j.1532-5415.2010.02751.x | pmc=PMC2947346 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20398129  }} </ref>
 
===Tailored, quantitative interaction===
A [[randomized controlled trial]] of patients at very high risk of coronary events found that use of two [[clinical prediction rule]]s (http://www.chiprehab.com/CVD/) for predicting coronary events along with tailored feedback, may improve cholesterol values.<ref name="pmidpending">Steven A. Grover et al., “Patient Knowledge of Coronary Risk Profile Improves the Effectiveness of Dyslipidemia Therapy: The CHECK-UP Study: A Randomized Controlled Trial,” Arch Intern Med 167, no. 21 (November 26, 2007), http://archinte.ama-assn.org/cgi/content/abstract/167/21/2296 (accessed November 27, 2007).</ref> In this trial, patients were also shown how their calculated risk changed over time and improved in response to changes in the patients' lifestyle changes and pharmacotherapy.
 
A cluster [[randomized controlled trial]] found that a cardiovascular risk calculator may reduce decisional regret.<ref name="pmid18474884">{{cite journal |author=Krones T, Keller H, Sönnichsen A, ''et al'' |title=Absolute cardiovascular disease risk and shared decision making in primary care: a randomized controlled trial |journal=Ann Fam Med |volume=6 |issue=3 |pages=218–27 |year=2008 |pmid=18474884 |doi=10.1370/afm.854 |url=http://www.annfammed.org/cgi/pmidlookup?view=long&pmid=18474884 |issn=}}</ref>
 
==References==
 
<references/>
 
==See also==
* [[Health behavior]][[Category:Suggestion Bot Tag]]

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Patient participation, also called shared decision making, is "patient involvement in the decision-making process in matters pertaining to health".[1] Usually health care providers explain treatments and alternatives to patients so that patients choose the course of action most consistent with their unique personal and cultural preferences. This concept may be contrasted with the paternalistic model of medical decision making, which was prevalent until the 1990s, in which doctors told patients what to do, and the patients unquestioningly obeyed[2].

Shared decision making combines evidence-based medicine with the preferences of patients.Many medical decisions are not strictly based on science. Patients have values that emphasize risks and benefits differently from their doctor. There is frequently more than one correct decision. Emerging importance of patient autonomy. Recognition of informed consent as an important component of decision making. Risk-benefit calculation renders not a single absolute recommendation but an assessment of outcome with more or less statistical certainty behind it.

Shared decision making emphasizes the importance of communication in the process of making a decision.

Shared decision making should be contrasted with informed consent, and simple consent.[3]

Legal rationale

Court cases such as the 1990 Cruzan v. Director, Missouri Department of Health Supreme Court case and the 1976 case of Karen Ann Quinlan have increased the importance of patient autonomy in medical ethics; shared decision making entails giving patients more influence in medical decisions.

Methods

Using computers to interact with patients

Internet websites may improve health behavior according to a randomized controlled trial.[4]

Internet websites for health promotion may improve health behavior according to a randomized controlled trial.[4]

Interactive software or Internet websites can help interact with the patient.[5][6][7] In some studies, Internet-based interventions improve upon usual care[8] whereas in other studies interpersonal interventions are better.[9]


The quality of online decision aids is uncertain.[10]

Shared decision making

Patient-centered strategies such as the patient choosing options may increase compliance.[11][12][13][14]

Tailored, quantitative interaction

A randomized controlled trial of patients at very high risk of coronary events found that use of two clinical prediction rules (http://www.chiprehab.com/CVD/) for predicting coronary events along with tailored feedback, may improve cholesterol values.[15] In this trial, patients were also shown how their calculated risk changed over time and improved in response to changes in the patients' lifestyle changes and pharmacotherapy.

A cluster randomized controlled trial found that a cardiovascular risk calculator may reduce decisional regret.[16]

References

  1. ↑ Anonymous (2024), Patient participation (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. ↑ Buchanan A (1978). "Medical paternalism". Philos Public Aff 7 (4): 370-90. PMID 11664929.
  3. ↑ Whitney SN, McGuire AL, McCullough LB (2004). "A typology of shared decision making, informed consent, and simple consent". Ann. Intern. Med. 140 (1): 54–9. PMID 14706973. [e]
  4. ↑ 4.0 4.1 Hughes SL, Seymour RB, Campbell RT, Shaw JW, Fabiyi C, Sokas R (2011). "Comparison of two health-promotion programs for older workers.". Am J Public Health 101 (5): 883-90. DOI:10.2105/AJPH.2010.300082. PMID 21421955. Research Blogging.
  5. ↑ Frosch, D. L., Bhatnagar, V., Tally, S., Hamori, C. J., & Kaplan, R. M. (2008). Internet patient decision support: a randomized controlled trial comparing alternative approaches for men considering prostate cancer screening, Arch Intern Med, 168(4), 363-369. doi: 10.1001/archinternmed.2007.111.
  6. ↑ Barry MJ (2002). "Health decision aids to facilitate shared decision making in office practice". Ann. Intern. Med. 136 (2): 127–35. PMID 11790064. [e]
  7. ↑ Kypri, Kypros; John D. Langley, John B. Saunders, Martine L. Cashell-Smith, Peter Herbison (2008-03-10). "Randomized Controlled Trial of Web-Based Alcohol Screening and Brief Intervention in Primary Care". Arch Intern Med 168 (5): 530-536. DOI:10.1001/archinternmed.2007.109. Retrieved on 2008-03-11. Research Blogging.
  8. ↑ Green, Beverly B.; Andrea J. Cook, James D. Ralston, Paul A. Fishman, Sheryl L. Catz, James Carlson, David Carrell, Lynda Tyll, Eric B. Larson, Robert S. Thompson (2008-06-25). "Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial". JAMA 299 (24): 2857-2867. DOI:10.1001/jama.299.24.2857. Retrieved on 2008-06-25. Research Blogging.
  9. ↑ Svetkey LP, Stevens VJ, Brantley PJ, et al (2008). "Comparison of strategies for sustaining weight loss: the weight loss maintenance randomized controlled trial". JAMA 299 (10): 1139-48. DOI:10.1001/jama.299.10.1139. PMID 18334689. Research Blogging.
  10. ↑ Levy AG, Sonnad SS, Kurichi JE, Sherman M, Armstrong K (2008). "Making sense of cancer risk calculators on the web". J Gen Intern Med 23 (3): 229-35. DOI:10.1007/s11606-007-0484-x. PMID 18188653. Research Blogging.
  11. ↑ Wong MC, Ching JY, Chan VC, Lam TY, Luk AK, Ng SC et al. (2014). "Informed choice vs. no choice in colorectal cancer screening tests: a prospective cohort study in real-life screening practice.". Am J Gastroenterol 109 (7): 1072-9. DOI:10.1038/ajg.2014.136. PMID 24935273. Research Blogging.
  12. ↑ Patel MR, Valerio MA, Janevic MR, Gong ZM, Sanders G, Thomas LJ et al. (2013). "Long-term effects of negotiated treatment plans on self-management behaviors and satisfaction with care among women with asthma.". J Asthma 50 (1): 82-9. DOI:10.3109/02770903.2012.743151. PMID 23189924. PMC PMC3617926. Research Blogging.
  13. ↑ Wilson SR, Strub P, Buist AS, Knowles SB, Lavori PW, Lapidus J et al. (2010). "Shared treatment decision making improves adherence and outcomes in poorly controlled asthma.". Am J Respir Crit Care Med 181 (6): 566-77. DOI:10.1164/rccm.200906-0907OC. PMID 20019345. PMC PMC2841026. Research Blogging.
  14. ↑ Gerber JB, Bloom PA, Ross JS (2010). "The physical activity contract--tailored to promote physical activity in a geriatric outpatient setting: a pilot study.". J Am Geriatr Soc 58 (3): 604-6. DOI:10.1111/j.1532-5415.2010.02751.x. PMID 20398129. PMC PMC2947346. Research Blogging.
  15. ↑ Steven A. Grover et al., “Patient Knowledge of Coronary Risk Profile Improves the Effectiveness of Dyslipidemia Therapy: The CHECK-UP Study: A Randomized Controlled Trial,” Arch Intern Med 167, no. 21 (November 26, 2007), http://archinte.ama-assn.org/cgi/content/abstract/167/21/2296 (accessed November 27, 2007).
  16. ↑ Krones T, Keller H, Sönnichsen A, et al (2008). "Absolute cardiovascular disease risk and shared decision making in primary care: a randomized controlled trial". Ann Fam Med 6 (3): 218–27. DOI:10.1370/afm.854. PMID 18474884. Research Blogging.

See also

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