Keeping the patient in the center: Common challenges in the practice of shared decision making

Patient Education and Counseling
Kimberly A FisherArwen H Pieterse

Abstract

To examine situations where shared decision making (SDM) in practice does not achieve the goal of a patient-centered decision. We explore circumstances in which elements necessary to realize SDM - patient readiness to participate and understanding of the decision - are not present. We consider the influence of contextual factors on decision making. Patients' preference and readiness for participation in SDM are influenced by multiple interacting factors including the patient's comprehension of the decision, their emotional state, the strength of their relationship with the clinician, and the nature of the decision. Uncertainty often inherent in information can lead to misconceptions and ill-formed opinions that impair patients' understanding. In combination with cognitive biases, these factors may result in decisions that are incongruent with patients' preferences. The impact of suboptimal understanding on decision making may be augmented by the context. There are circumstances in which basic elements required for SDM are not present and therefore the clinician may not achieve the goal of a patient-centered decision. A flexible and tailored approach that draws on the full continuum of decision making models and communication st...Continue Reading

Citations

Dec 21, 2019·Nursing Inquiry·Julie Mondahl, Kirsten Frederiksen
Aug 12, 2020·BMC Health Services Research·Cosima LocherStefan Büchi
Jul 2, 2020·International Journal of Integrated Care·Annerieke StoopUNKNOWN SUSTAIN consortium
Jul 11, 2020·The Journal of Craniofacial Surgery·Kavitha RanganathanJennifer F Waljee
Dec 16, 2020·Medical Decision Making : an International Journal of the Society for Medical Decision Making·Natalie Joseph-WilliamsTrudy van der Weijden
Nov 3, 2020·The Journal of Craniofacial Surgery·Kavitha RanganathanJennifer F Waljee
Mar 29, 2021·Health Expectations : an International Journal of Public Participation in Health Care and Health Policy·Emma Forsgren, Ida Björkman
Oct 13, 2020·Patient Education and Counseling·Anke J M OerlemansGert J Olthuis
Jun 23, 2021·Nursing·Marguerite Peggy Anderson, Eira Kristiina Hyrkas
May 18, 2021·Journal of the American College of Cardiology·UNKNOWN Executive CommitteeRichard E Anderson
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