Health Care Decisions & Advance Directives
Shared Decision Making
Often, decisions about the right course of treatment are straightforward and easy to make. The easiest decisions are those in which everyone agrees on the goal, there is only one standard treatment, the treatment is not risky or burdensome and it reliably produces a good outcome.
But many decisions are not so easy to make. Sometimes there are several options, each with different potential risks and benefits, but none is clearly “best.” Or maybe one treatment is considered medically best, but it is not a cure or it has an uncertain outcome or side effects that may be difficult for the patient to endure.
In these cases, the right course of treatment is the one that is right for the individual patient, considering his or her personal preferences and views of the risks, benefits and burdens of the various options.
Decision-making in such cases requires close collaboration between physician and patient, with the physician using his or her medical expertise to guide the patient’s choice in accordance with the patient’s goals.
Such collaboration is the hallmark of Shared Decision-Making. In the Shared Decision-Making model, the physician shares with the patient all relevant risk and benefit information on all treatment options and the patient shares with the physician all relevant personal information that might make one treatment more appropriate than the others.
Through dialogue, the physician learns how the patient views the risks and benefits of the various options and what issues are most relevant to the patient. He or she then helps the patient think about risks and benefits in terms of the values and preferences the patient has expressed. Together physician and patient use the shared information to come to a mutually acceptable decision.
Shared Decision-Making has been hailed for improving patient comprehension, increasing communication and trust and reducing unwanted medical procedures. It also helps to maintain balance between the physician’s sometimes competing ethical duties to do what is best for the patient (the duty of “beneficence”) while honoring the patient’s right to self-determination (the duty of “autonomy”).
For more information, see:
- VEN Newsletter – Fall 2010 Edition
- The complete chapter on Shared Decision Making by Dr. Denise Niemira. Found in Chapter 8 of the Handbook for Rural Ethics: A Practical Guide for Professionals
- The Center for Shared Decision-Making at Dartmouth Hitchcock Medical Center. They offer:
- One-on-one counseling sessions for any medical condition
- A Decision Aid Library of helpful videotapes, audiotapes, booklets, CD-ROMs, and websites
- A Healthcare Decision Guide to help you work through a decision on your own
Visit The Center for Shared Decision-Making for more information.