Final Report: The Practice and Impact of Shared Decision-Making

Several recent developments are likely to address those factors seen as contributing to shared decision-making’s mixed results: the lack of a nationally recognized certification process; insufficient funds to adequately invest in the training and infrastructure to support shared decision-making; and adequate methods for monitoring its effectiveness

Shared Decision Making in the Psychiatric Inpatient Setting: An Ethnographic Study about Interprofessional Psychiatric Consultations

Shared decision making is increasingly receiving attention in health care and might improve both the quality of care and patient outcomes. Nevertheless, due to its complexity, implementation of shared decision making in clinical practice seems challenging. This ethnographic study aimed to gain a better understanding of how psychiatric inpatients and the interprofessional care team interact during regular interprofessional psychiatric consultations. Data were collected through participant observation on two different psychiatric wards in a large psychiatric hospital in Switzerland. The observation focused on the contextual aspects of interprofessional patient consultations, the communication and interaction as well as the extent to which patients were involved in decision making. Participants included patients, psychiatrists, junior physicians, nurses, psychologists, social workers and therapists. We observed 71 interprofessional psychiatric consultations and they differed substantially in both wards in terms of context (place and form) and culture (way of interacting). On the contrary, results showed that the level of patient involvement in decision making was comparable and depended on individual factors, such as the health care professionals' communication style as well as the patients' personal initiative to be engaged. The main topics discussed with the patients related to pharmacotherapy and patient reported symptoms. Health care professionals in both wards used a rather unidirectional communication style. Therefore, in order to promote patient involvement in the psychiatric inpatient setting, rather than to focus on contextual factors, consultations should follow a specific agenda and promoting a bidirectional communication style for all parties involved is strongly recommended

How do nurses facilitate shared decision making in HIV care?: an exploratory study of UK nurses knowledge, perspective and experience of facilitating shared decision making in clinical practice

Shared Decision Making (SDM) enables clinicians to promote self-management and to empower patients with long-term health conditions. Whilst it has been reported in other health conditions, there is little empirical research on the nature and practice of SDM in HIV care. This project aimed to explore current views and practices amongst UK HIV Nurses regarding SDM. A mixed methods study utilised focus groups and an online survey to identify opportunities, challenges and training needs. Nurses are supportive of SDM but face patient related, organisation and health system challenges to implement it, especially in supporting complex patients. SDM is an important aspect of nursing care for people living with HIV. Nurses need more training and resources to implement SDM effectively. In order to develop such training and resources to better understand SDM in relation to HIV care, there is a need for research on patient perspectives and experiences in this area

Shared Decision Making

This chapter is divided into three sections. The first section introduces the concept and models of shared decision-making as a framework of person- centered care. The second section focuses on multicriteria decision-making tech- niques in healthcare settings and literature review about multicriteria decision making analysis methods used in healthcare is presented. The third section introduces the ethical and practical considerations about shared decision-making in person-centered care. In this section, the patient narratives are included, as well as the barriers to implementation

Getting Obligations Right: Autonomy and Shared Decision Making

Shared Decision Making (‘SDM’) is one of the most significant developments in Western health care practices in recent years. Whereas traditional models of care operate on the basis of the physician as the primary medical decision maker, SDM requires patients to be supported to consider options in order to achieve informed preferences by mutually sharing the best available evidence. According to its proponents, SDM is the right way to interpret the clinician-patient relationship because it fulfils the ethical imperative of respecting patient autonomy. However, there is no consensus about how decisions in SDM contexts relate to the principle of respect for autonomy. In response, I demonstrate that in order to make decisions about what treatment they will or will not receive, patients will be required to meet different conditions depending on the approach proponents of SDM take to understanding personal autonomy. Due to the fact that different conceptions of autonomy yield different obligations, I argue that if physicians and patients satisfied all the conditions described in standard accounts of SDM, then SDM would undermine patient autonomy

Common Sense is Not Common. So How Can A Leader Make Good Decisions?

In education today there is a move away from top-down leadership toward a more inclusive, shared or participative leadership model. This model includes shared decision-making, which has the potential to empower and radically change any organization willing to take the risk of implementing this type of leadership. This article combines another important aspect of leadership to the concept of shared decision-making: servant leadership. With a servant-leader at the helm and shared decision-making in place, a school has the potential to grow in sync with the needs and desires of its stakeholders

Shared Decision Making in Endodontics.

File replaced (incorrect version) on 6/7/2022 by KT (LDS).Engaging patients in shared decision making (SDM) is a professional requirement since the Montgomery ruling in 2015. Endodontic treatments present a specific challenge to achieving SDM, both for the clinician and the patient. The treatments are often perceived as more challenging to complete by the clinician, and the assessment of risk and likely outcome requires a deep understanding of the (limited) evidence base. For the patient, decisions can be required at a time of acute symptoms and prolonged treatments. There are health literacy demands in comparison to some less complex dental treatments. Treatment decisions may be based more on inherent biases and prior experiences than objective probabilities. This article discusses options and supports effective shared decision making in endodontic treatment

Patient centred diagnosis: sharing diagnostic decisions with patients in clinical practice.

Patient centred diagnosis is best practised through shared decision making; an iterative dialogue between doctor and patient, whichrespects a patient’s needs, values, preferences, and circumstances. Shared decision making for diagnostic situations differs fundamentally from that for treatment decisions. This has important implications when considering its practical application. The nature of dialogue should be tailored to the specific diagnostic decision; scenarios with higher stakes or uncertainty usually require more detailed conversation

Patients’ understanding of shared decision-making in a mental health setting: The importance of the patient-provider relationship

Shared decision making is a fundamental component of patient-centered care and has been linked to positive health outcomes. Increasingly, researchers are turning their attention to shared decision making in mental health; however, few studies have explored decision making in these settings from patients’ perspectives. We examined patients’ accounts and understanding of shared decision making. We analyzed interviews from 54 veterans receiving outpatient mental health care at a Department of Veterans Affairs Medical Center in the United States. Although patients’ understanding of shared decision making was consistent with accounts published in the literature, participants reported that shared decision making goes well beyond these components. They identified the patient–provider relationship as the bedrock of shared decision making and highlighted several factors that interfere with shared decision making. Our findings highlight the importance of the patient–provider relationship as a fundamental element of shared decision making and point to areas for potential improvement