Research ArticlesShared decision making in clinical medicine: past research and future directions
Section snippets
Why shared decision making?
The classic view of the sick-role, as conceptualized by Parsons,8 sees the patient as exempted from his or her societal role by a physician. A sick patient attains this privilege by submitting to the physician’s directives. Following the prescribed course of treatment is expected to bring about relief and limit the time spent in the sick-role. According to this model, which has predominated medical treatment for many decades, the physician is dominant and autonomous and bears sole
Do patients want to engage in shared medical decision making?
A central question to the shared decision-making paradigm is whether patients actually want to participate in medical decision making. Several studies have addressed this question, and results of these studies have been mixed. A summary of these results appears in Table 1.
Cassileth and colleagues32 examined the extent to which cancer patients with varied diagnoses wanted to participate in treatment decisions. Most participants indicated a desire to participate in treatment decisions. However,
Do physicians want to engage in shared medical decision making?
A patient’s wish to participate in clinical decision making will have little impact if the physician is not open to the process. Despite the increasing shift toward patient-centered medicine in recent years,45 we were unable to locate studies that directly surveyed large samples of physicians regarding their views on shared decision making. While academic medicine espouses shared decision making as the clinical ideal, it is unclear how nonacademic physicians are inclined toward this paradigm.
How is shared decision making implemented and what are the results?
The basic preconditions to shared decision making between physician and patient have been outlined, but meeting these conditions may not always prove sufficient to confront the complexity of medical decision making. To date, limited research has focused on two areas: increasing a patient’s ability to engage physicians in a dialogue that facilitates shared decision making and providing patients with balanced reviews of treatment options and consequences.
Greenfield et al6 designed an intervention
Summary and future directions
There are a number of unresolved questions related to the implementation of shared decision making. The evidence regarding patient interest in decision making is mixed. Some studies have found little interest in shared decision making, while others find most patients desiring some control over decision making. The distinction between technical problem-solving issues and decisions that pertain to treatment outcomes is crucial in explaining the reluctance some patients have, but further research
Acknowledgements
Supported in part from a Scholars Grant from the American Cancer Society.
The authors gratefully acknowledge comments by Steven H. Woolf, MD, MPH, on an earlier draft of this paper.
References (55)
- et al.
Shared decision making in the medical encounterwhat does it mean?
Soc Sci Med
(1997) - et al.
Colorectal cancer screeningclinical guidelines and rationale
Gastroenterology
(1997) - et al.
Developing shared decision-making programs to improve the quality of health care
Qual Rev Bull
(1992) - et al.
Appropriateness and variation of surgical treatment of breast cancer in Italywhen excellence in clinical research does not match with generalized good quality care
J Clin Epidemiol
(1995) - et al.
Overconfidence among physicians and nursesthe “micro-certainty, macro-uncertainty” phenomenon
Soc Sci Med
(1991) - et al.
Preferences for health care involvement, perceived control and surgical recoverya prospective study
Soc Sci Med
(1990) The patient’s role in clinical decision making
Ann Intern Med
(1980)- et al.
American Cancer Society guideline for the early detection of prostate cancerupdate 1997
CA Cancer J Clin
(1997) - et al.
Prostate Cancer Clinical Guidelines PanelReport on the Management of Clinically Localized Prostate Cancer
(1995) - et al.
Early detection of prostate cancer. Clinical GuidelinePart III
Ann Intern Med
(1997)
National Institutes of Health consensus development conference statementBreast cancer screening for women ages 40–49; January 21–23, 1997
J Natl Cancer Inst
The Social System
The patient-physician partnershipchanging roles and the desire for information
Can Med Assoc J
Just Doctoring
Consultation and patient information on the Internetthe patients’ forum
Br J Urol
Communicating breast cancer on-lineSupport and empowerment on the Internet
Women & Health
Reliability of health information for the public on the world wide websystematic survey of advice on managing fever in children at home
BMJ
What is inappropriate care?
JAMA
Science, ethics, and the making of clinical decisions
JAMA
The Dartmouth Atlas of Health Care 1998
An assessment of prostatectomy for benign urinary tract obstruction
JAMA
Symptom status and quality of life following prostatectomy
JAMA
The effect of a shared decision-making program on rates of surgery for benign prostatic hyperplasia
Med Care
Speech and survivaltrade-offs between quality and quantity of life in laryngeal cancer
N Engl J Med
Health values of hospitalized patients 80 years or older
JAMA
Anatomy of a decision
JAMA
Expanding patient involvement in care
Ann Intern Med
Cited by (515)
A scoping review into the explanations for differences in the degrees of shared decision making experienced by patients
2024, Patient Education and CounselingOnline information search by people with Multiple Sclerosis: A systematic review
2023, Multiple Sclerosis and Related DisordersPatient and clinician perspectives on shared decision-making in infertility treatment: A qualitative study
2023, Patient Education and CounselingAssessing the impact of patient-involvement healthcare strategies on patients, providers, and the healthcare system: A systematic review
2023, Patient Education and Counseling“Good people don't need medication”: How moral character beliefs affect medical decision making
2023, Organizational Behavior and Human Decision ProcessesExamining the knowledge work of person-centred care: Towards epistemic reciprocity
2023, Patient Education and Counseling