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Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango)
Abstract
Shared decision-making is increasingly advocated as an ideal model of treatment decision-making in the medical encounter. To date, the concept has been rather poorly and loosely defined. This paper attempts to provide greater conceptual clarity about shared treatment decision-making, identify some key characteristics of this model, and discuss measurement issues. The particular decision-making context that we focus on is potentially life threatening illnesses, where there are important decisions to be made at key points in the disease process, and several treatment options exist with different possible outcomes and substantial uncertainty. We suggest as key characteristics of shared decision-making (1) that at least two participants-physician and patient be involved; (2) that both parties share information; (3) that both parties take steps to build a consensus about the preferred treatment; and (4) that an agreement is reached on the treatment to implement. Some challenges to measuring shared decision-making are discussed as well as potential benefits of a shared decision-making model for both physicians and patients.
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“The shared decision making model suggests that HCPs can facilitate shared decisions by presenting treatment options, outlining the benefits and risks, and helping patients/caregivers to evaluate these options against their own goals and preferences.[36–37]”
From Perceived healthcare provider reactions to patient and caregiver use of online health communities (2014) · cites this paper as [37]
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BackgroundImpact of Shared-Decision Making on Patient Satisfaction
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“이미 미국이나 영국 등에서는 이러 한 공유의사결정의 중요성과 유효성을 언급하면서 의과대 학 교과과정이나 교육프로그램 등을 활용, 공유의사결정에 대한 교육 및 훈련이 이루어져야 한다는 점에 공감대가 형 성되고 있다 [5,17,18].”
Client communication behaviors with health care providers in Indonesia
Kim, Y. M., Kols, A., Bonnin, C., Richardson, P., & ROTER, D. L. (2001) · Patient Education and Counseling · doi:10.1016/s0738-3991(01)00144-6 · Cited by 58
“Although most clients want to know more about their condition than providers tell them and to discuss their concerns (Charles et al. 1997; Street 1991), clients fear that providers will dismiss or devalue their comments and questions.”
BackgroundArcand, M. (2015) · PubMed Central · Cited by 58
Slevin, P., & Caulfield, B. (2018) · Elsevier eBooks · doi:10.1016/b978-0-12-811810-8.00013-0 · Cited by 59
WORKBOOK ON DEVELOPING AND EVALUATING PATIENT DECISION AIDS
Jacobsen, M. (2003) · Cited by 58
Compromised Autonomy and the Seriously Ill Patient
Tonelli, M. R., & Misak, C. J. (2010) · Chest · doi:10.1378/chest.09-1574 · Cited by 57
Stein, B. D., Kogan, J. N., Mihalyo, M. J., Schuster, J., Deegan, P. E., Sorbero, M., & Drake, R. E. (2012) · Community Mental Health Journal · doi:10.1007/s10597-012-9528-8 · Cited by 57
Exploring Cancer Treatment Decision-Making by Patients: A Descriptive Study
Stacey, D., Paquet, L., & Samant, R. S. (2010) · Current Oncology · doi:10.3747/co.v17i4.527 · Cited by 57
The desire for shared decision making among patients with solid and hematological cancer
Ernst, J., Kuhnt, S., Schwarzer, A., Aldaoud, A., Niederwieser, D. W., Mantovani‐Löffler, L., Kuchenbecker, D., & Schröder, C. (2010) · Psycho-Oncology · doi:10.1002/pon.1723 · Cited by 57
Weiss, M., & Peters, T. J. (2007) · Patient Education and Counseling · doi:10.1016/j.pec.2007.09.001 · Cited by 57
Decisional capacity: toward an inclusionary approach
Peisah, C., Sorinmade, O. A., Mitchell, L. K., & Hertogh, C. M. P. M. (2013) · International Psychogeriatrics · doi:10.1017/s1041610213001014 · Cited by 57
“Often there are time constraints that limit the application of shared decision-making; further, there is a tendency among patients to be less willing to play an active role in decision-making as their illness increases in severity (Charles et al., 1997; Gravel et al., 2006).”
BackgroundComputer-Based Learning Module Increases Shared Decision Making in Breast Reconstruction
Lee, B. T., Chen, C., Yueh, J. H., Nguyen, M.-D. T., Lin, S. J., & Tobias, A. M. (2009) · Annals of Surgical Oncology · doi:10.1245/s10434-009-0869-7 · Cited by 57
Parental Personal Sense of Duty as a Foundation of Pediatric Medical Decision-making
Feudtner, C., Schall, T. E., & Hill, D. L. (2018) · PEDIATRICS · doi:10.1542/peds.2018-0516c · Cited by 57
Boiko, O. V., Gulliford, M. C., & Burgess, C. C. (2020) · Health Expectations · doi:10.1111/hex.13102 · Cited by 57
Gambling with your life: The process of breast cancer treatment decision making in Chinese women
Lam, W., Fielding, R., Chan, M. C., Chow, L. W., & Or, A. (2004) · Psycho-Oncology · doi:10.1002/pon.803 · Cited by 57
“Shared decision-making is preferred by many patients (Charles et al., 1997; Fielding 1995; Fallowfield et al., 1990; Gattellari et al., 2001; Lam et al., 2003).”
Roberts, C., Sarangi, S., & Moss, B. (2004) · Communication & Medicine · doi:10.1515/come.2004.1.2.159 · Cited by 57
“Critiques of the patient-centred model, as it is advocated, recognize that patients may resist this approach ( Charles et al. 1997; Elwyn at al. 1999) but have not raised questions about what happens when patients in all their variety and distinctiveness meet the apparently orderly consultation.”
Metadata
- Authors
- Charles, C., Gafni, A., & Whelan, T.
- Affiliations
- McMaster University (CA)
- Corresponding author
- Charles, Cathy
- ORCID
- Gafni, Amiram
- Venue
- Social Science & Medicine
- Publisher
- Elsevier BV
- Published
- 1997-03
- Volume
- 44
- Issue
- 5
- Pages
- 681-692
- ISSN
- 0277-9536 (ISSN-L)
- OpenAlex
- W2040607890
- Cited by
- 4,137
- References
- 68
- Citations by year
- 2026: 168 · 2025: 200 · 2024: 224 · 2023: 213 · 2022: 174 · 2021: 247 · 2020: 250 · 2019: 233 · 2018: 224 · 2017: 234 · 2016: 209 · 2015: 182 · 2014: 221 · 2013: 192 · 2012: 187
- FWCI
- 63.23
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Social Science & Medicine (publishedVersion)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Keywords
- shared decision-making, physician-patient relationship, treatment decision-making, shared information, consensus building, patient involvement in care
- MeSH terms
- Decision Making, Humans, Informed Consent, Models, Psychological, Patient Participation, Physician-Patient Relations, Patient Satisfaction
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