What Is Shared Decision Making? (and What It Is Not)

Kunneman, Marleen; Montori, Víctor M.; Castañeda-Guarderas, Ana; Hess, Erik P.

doi:10.1111/acem.13065

Cited by 118 publications

(108 citation statements)

References 19 publications

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“…Lack of concern for patient expectation has a negative impact on the appreciation of care and overall satisfaction, and can be a source of conflict between the patient and the health system. [34][35][36][37] Since clinical outcomes are equal and patients seem to prefer the single port approach, the logical conclusion should be that uncomplicated gallbladder disease has to be operated on by single port laparoscopy. There are, however, some caveats.…”

Section: Discussionmentioning

confidence: 99%

Patient preference matters: cholecystectomy for uncomplicated gallbladder diseases should be performed by single port laparoscopy

et al. 2017

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Background: Laparoscopic cholecystectomy for uncomplicated gallbladder diseases (UGD) is a low-complexity procedure with little morbidity. Single port approach (SPA) benefits are unclear. Our aim is to identify any advantages by evaluating both the clinical outcomes of this approach and also patient opinion, following a year of implementation in our institution.Methods: Data from patients operated on during 2015 for UGD by SPA or conventional laparoscopic approach (CLA) were collected. Patients were asked to answer a telephone questionnaire 4-6 months after the operation.Results: 47 patients were operated on by SPA (SP group) and 117 by CLA (CL group). No differences were found between preoperative variables, surgical time, morbidity, length of stay or wound complications. More SP group patients reported no pain at discharge (72.3 vs 54.7%, p=0.037). 138 patients answered the questionnaire. No significant differences were found when comparing overall satisfaction. Wound aspect satisfaction was higher in the SP group (100 vs 80.9%, p=0.001). A higher proportion of CL group patients felt that had they had fewer scars, they would be more satisfied (46.8 vs 9.1%, p <0.001), and 35.1% of them opined that their satisfaction would be greater had they been operated on by SPA. In the multivariate analysis, the only variable associated with maximum overall satisfaction was wound aspect satisfaction.Conclusions: SPA is a valid alternative to CLA for UGD. It should be chosen when available, since it provides equal clinical outcomes, diminishes postoperative pain and is preferred by patients.

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Section: Discussionmentioning

confidence: 99%

Patient preference matters: cholecystectomy for uncomplicated gallbladder diseases should be performed by single port laparoscopy

et al. 2017

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“…This is considered particularly pertinent when more than one reasonable approach is available to manage the patient's situation (including doing nothing else) and when these approaches differ in ways that matter to these patients 1, 2, 3. In shared decision making (SDM), clinicians and patients work together to figure out how to best address the patient's situation and to make decisions about health and care that fit each patient and their lives 4 . Most SDM models distinguish 3 key steps before reaching a decision: (1) creating choice awareness, (2) discussing the relevant options, and (3) discussing patient preferences 2, 3, 5.…”

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confidence: 99%

Fostering Choice Awareness for Shared Decision Making: A Secondary Analysis of Video-Recorded Clinical Encounters

Kunneman

Branda

Hargraves

et al. 2018

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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ObjectiveTo assess the extent to which (1) clinicians, using or not using conversation aids, foster choice awareness during clinical encounters and (2) fostering choice awareness, with or without conversation aids, is associated with greater patient involvement in shared decision making (SDM).Patients and MethodsWe randomly selected 100 video-recorded encounters, stratified by topic and study arm, from a database of 10 clinical trials of SDM interventions in 7 clinical contexts: low-risk acute chest pain, stable angina, diabetes, depression, osteoporosis, and Graves disease. Reviewers, unaware of our hypothesis, coded recordings with the OPTION-12 scale to quantify the extent to which clinicians involved patients in decision making (SDM, 0-100 score). Blinded to OPTION-12 scale scores, we used a self-developed coding scale to code whether and how choice awareness was fostered.ResultsClinicians fostered choice awareness in 53 of 100 encounters. Fostering choice awareness was associated with a higher OPTION-12 scale score (adjusted [for using vs not using a conversation aid] predicted mean difference, 20; 95% CI, 11-29). Using a conversation aid was associated with a higher, nonsignificant chance of fostering choice awareness (N=31 of 50 [62%] vs N=22 of 50 [44%]; adjusted [for trial] P=.34) and with a higher OPTION-12 scale score, although adjusting for fostering choice awareness mitigated this effect (adjusted predicted mean difference 5.8; 95% CI, −1.3-12.8).ConclusionFostering choice awareness is linked to a better execution of other SDM steps, such as informing patients or discussing preferences, even when SDM tools are not available or not used.

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“…In a conversational dance, clinicians and patients work together to think, talk and feel through the situation of the patient and identify sensible ways to address this situation 4 5. The two-way information sharing in SDM,6 7 both by the clinician presenting the relevant options and the patient articulating what matters to him, is relevant for this particular patient and is relevant for comparing different options and choosing one that fits.…”

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confidence: 99%

“…The two-way information sharing in SDM,6 7 both by the clinician presenting the relevant options and the patient articulating what matters to him, is relevant for this particular patient and is relevant for comparing different options and choosing one that fits. In contrast, informed consent procedures seem independent of who this patient is and cover topics that are relevant for all people like this patient 5. Unlike the conversational dance in SDM that requires a human connection of careful and kind care, informed consent procedures call for a more technical and mechanical approach, a formal one-way provision of information in which boxes of topics addressed are to be actually or metaphorically ticked for administrative and legal purposes.…”

mentioning

confidence: 99%

When patient-centred care is worth doing well: informed consent or shared decision-making

Kunneman

Montori

2016

BMJ Qual Saf

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What Is Shared Decision Making? (and What It Is Not)

Cited by 118 publications

References 19 publications

Patient preference matters: cholecystectomy for uncomplicated gallbladder diseases should be performed by single port laparoscopy

Patient preference matters: cholecystectomy for uncomplicated gallbladder diseases should be performed by single port laparoscopy

Fostering Choice Awareness for Shared Decision Making: A Secondary Analysis of Video-Recorded Clinical Encounters

When patient-centred care is worth doing well: informed consent or shared decision-making

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