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Informed Decision Making

~ Informed Consent ~ Informed Declination ~ Shared Decision Making ~

Much more than just signing consent forms & delegating your care to others...

Shifting From Shared to Collaborative Decision Making:

Collaborative Decision Making: A Real-world Example


In 2002, Coulter[33] inquired, "Is shared decision making doomed to remain the obsession of a few academic pointy heads?" She may have been right.

Improved outcomes may be achieved by shifting the focus from shared decision making to a collaborative model. This requires a change in "thinking" as well as "doing" by clinicians and patients. In this form of integrated knowledge translation[34] both parties must acknowledge that learning from each other and building a common pool of knowledge will lead to a more balanced, satisfactory and ultimately appropriate form of care. However, much work needs to be done if patients are to work with clinicians on a "level playing field." Other sectors of society, including the traditionally conservative banking and insurance industries, have changed substantially the way in which they interact with their customers. Necessity, the mother of innovation, has played a crucial role in this shift.

As we face a potentially unsustainable health system, both clinicians and patients have a responsibility to help promote optimal health through the innovative use of the powerful information and communication technologies they have available to them. The rapid penetration of mobile phones and social networking tools throughout the world indicates that the public is ready for this shift. Will clinicians be willing to join in and foster the transformation of their relationship with patients?[35]

Towards a feasible model for shared decision making:
focus group study with general practice registrars

BMJ 1999;319doi: 10.1136/bmj.319.7212.753(Published 18 September 1999)


Objectives: To explore the views of general practice registrars about involving patients in decisions and to assess the feasibility of using the shared decision making model by means of simulated general practice consultations.

Design: Qualitative study based on focus group interviews.

Setting: General practice vocational training schemes in south Wales.

Participants: 39 general practice registrars and eight course organisers (acting as observers) attended four sessions; three simulated patients attended each time.

Method: After an introduction to the principles and suggested stages of shared decision making the registrars conducted and observed a series of consultations about choices of treatment with simulated patients using verbal, numerical, and graphical data formats. Reactions were elicited by using focus group interviews after each consultation and content analysis undertaken.

Results: Registrars in general practice report not being trained in the skills required to involve patients in clinical decisions. They had a wide range of opinions about “involving patients in decisions,” ranging from protective paternalism (“doctor knows best”), through enlightened self interest (lightening the load), to the potential rewards of a more egalitarian relationship with patients. The work points to three contextual precursors for the process: the availability of reliable information, appropriate timing of the decision making process, and the readiness of patients to accept an active role in their own management.

Conclusions: Sharing decisions entails sharing the uncertainties about the outcomes of medical processes and involves exposing the fact that data are often unavailable or not known; this can cause anxiety to both patient and clinician. Movement towards further patient involvement will depend on both the skills and the attitudes of professionals, and this work shows the steps that need to be taken if further progress is to be made in this direction.

Key Messages:

  • Involvement of patients in decisions about their treatment or care is increasingly advocated
  • Registrars in general practice report not receiving training in the skills needed for successful involvement of patients in decision making
  • Attitudes towards involving patients range from being highly positive to being more circumspect
  • Moves towards enhancing patient involvement in decision making will depend on developing both skills and attitudes of professionals

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