A patient in the clinic; a person in the world. Why shared decision making needs to center on the person rather than the medical encounter |
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| Affiliation: | 1. American Institutes for Research, Chicago, USA;2. Institute of Clinical Medicine, Campus Ahus, University of Oslo, Norway;3. Akershus University Hospital, Lillestrøm, Norway;4. University of Colorado, Aurora, CO, USA;1. Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Postbus 9101, 6500 HB Nijmegen, The Netherlands;2. Academic Educational Institute, Radboud University Nijmegen Medical Centre, Postbus 9101, 6500 HB Nijmegen, The Netherlands;3. Department of Internal Medicine, Haga Teaching Hospital, Postbus 40551, 2504 LN The Hague, The Netherlands;4. Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Postbus 9101, 6500 HB Nijmegen, The Netherlands;5. Department of Geriatrics, Radboud University Nijmegen Medical Centre, Postbus 9101, 6500 HB Nijmegen, The Netherlands;6. Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Postbus 9101, 6500 HB Nijmegen, The Netherlands;1. Center for Health Promotions and Research, University of Texas School of Public Health, San Antonio, USA;2. Massey Cancer Center and Department of Social and Behavioral Health, Virginia Commonwealth University, Richmond, USA;1. Department of Family Practice, School for Public Health and Primary Care CAPHRI Maastricht University, Maastricht, NL;2. Dutch Federation of Patient Organisations, Utrecht, NL;3. Isala Women''s and Children''s Hospital, Zwolle, and UMCG Postgraduate School of Medicine, University Medical Centre and University of Groningen, Groningen, NL;4. Trant voor de zorg van morgen, zelfstandig adviesbureau., Wijk bij Duurstede, NL;5. Dutch College of General Practitioners, Utrecht, Utrecht, NL;6. Program manager health care innovation, CZ Health Care Insurance, Tilburg, NL;7. Health Evidence, Radboud University Medical Centre, Nijmegen, NL;8. Department of Public and Occupational Health and Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, NL;9. Department of Medical Decision Making, Leiden University Medical Centre, Leiden, NL;1. Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, USA;2. Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, USA;3. Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, USA;4. Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic, Rochester, USA;5. Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA;6. Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, USA;7. Program in Bioethics, Mayo Clinic, Rochester, USA;8. Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands;1. School of Population and Public Health, University of British Columbia, Vancouver, Canada;2. Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Research Institute, Vancouver, Canada;3. Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, Canada |
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| Abstract: | Interest in shared decision making (SDM) has increased and become widely promoted. However, from both practical and measurement perspectives, SDM’s origin as an outgrowth of patient autonomy has resulted in narrowly conceptualizing and operationalizing decision making. The narrow focus on individual patient autonomy fails in four main ways: 1) excluding several facets of the roles, actions, and influences of decision partners in decision making; 2) focusing solely on the medical encounter; 3) ignoring the informational environment to which patients have access; and 4) treating each encounter as independent of all others. In addition to creating a research agenda that could answer important outstanding questions about how decisions are made and the consequences thereof, reconceiving SDM as centered on the person rather than the medical encounter has the potential to transform how illness is experienced by patients and families and how clinicians find meaning in their work. |
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| Keywords: | Shared decision making Patient-centered care Family engagement Decision partner |
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