What Is Shared in Shared Decision Making? Complex Decisions When the Evidence Is Unclear

Epstein, Ronald M.; Gramling, Robert

doi:10.1177/1077558712459216

Cited by 144 publications

(136 citation statements)

References 71 publications

Supporting

Mentioning

126

Contrasting

Order By: Relevance

“…Assessing the patient's ability to understand this information is one element of assessing decision-making capacity (Appelbaum 2007). If the patient does not seem to fully grasp the information that was conveyed, the clinician will want to determine whether this reflects a true inability to understand the material or whether the explanation needs to be worded in more straightforward terms (Epstein and Gramling 2013;Epstein and Peters 2009;Sessums et al 2011;Sheridan et al 2004). Shifting to a different mode or format of presentation may also help improve the patient's understanding of the material (Covey 2007).…”

Section: Methodsmentioning

confidence: 99%

“…The clinician could discuss the likely diagnostic possibilities or explain why symptomatic treatment is still indicated, even in the absence of a clear diagnosis. Other elements of the proposed treatment approach may also contain uncertainties (Epstein and Gramling 2013), and gaps in available evidence may not allow estimates of risks and benefits of treatment. Again, the goal is a straightforward discussion of the therapeutic options as well as transparent mention of key areas of uncertainty that would be relevant to the patient's preferences and decisions.…”

Section: Methodsmentioning

confidence: 99%

“…Furthermore, these preferences can be difficult to judge (Kon 2012) and may be culturally mediated (Charles et al 2006). They are not absolute but may shift with the clinical context or type of decision that is being made (Epstein and Gramling 2013). Fewer studies are available in psychiatric patients, but these also suggest individual variations in preferences (Deegan and Drake 2006;Klein et al 2007;Woltmann and Whitley 2010).…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults

Association¹

2015

View full text Add to dashboard Cite

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults

Association¹

2015

View full text Add to dashboard Cite

show abstract

“…What happens when the evidence is poor or options are ambiguous is less clear and requires a different approach. 42 And for patients who prefer to delegate treatment decisions, what is the provider responsibility for defining preferred wound outcome?…”

mentioning

confidence: 99%

What Do Patients Want? Patient Preference in Wound Care

Corbett

Ennis

2014

Advances in Wound Care

View full text Add to dashboard Cite

Patient preferences are statements made or actions taken by consumers that reflect their desirability of a range of health options. The concept occupies an increasingly prominent place at the center of healthcare reform, and is connected to all aspects of healthcare, including discovery, research, delivery, outcome, and payment. Patient preference research has focused on shared decisions, decisional aids, and clinical practice guideline development, with limited study in acute and chronic wound care populations. The wound care community has focused primarily on patient focused symptoms and quality of life measurement. With increasing recognition of wound care as a medical specialty and as a public health concern that consumes extensive resources, attention to the preferences of end-users with wounds is necessary. This article will provide an overview of related patient-centered concepts and begin to establish a framework for consideration of patient preference in wound care.From the seminal models of evidence-based practice, patient preference has occupied a prominent place in clinical decision making. More recently, consideration for patient preference emerges as a key component in the redesign of healthcare processes with significance for improving outcome and safety.2 But what are patient preferences? How are they elicited, regarded, and incorporated into recommended action? What interrelated patient-centered concepts have been studied in various patient populations? Lastly, what contribution has the wound care community made to the understanding of patient preference? This article aims to introduce the reader to the issues, begin a dialogue on patient preference in wound care, and suggest opportunities for future discovery.Patient preferences are ''statements by individuals regarding the relative desirability of a range of health experiences, treatment options and health states.'' 3(p259) Preferences reflect beliefs and attitudes of the patient and family, and are related to the process, probability, and severity of potential choices. 4 Patient preference is conceptualized and measured differently across disciplines, from health economics, patient education, psychology, ethics, and using qualitative and quantitative approaches. In the field of medicine, oncology has been the frontrunner in operationalizing methods to determine patient preference for various cancer treatment options, most notably in breast and prostate cancer treatments.

show abstract

“…Briefly, patients must decide not only through a theoretical exercise, but considering the context that preserves the expression of their autonomy, in which there must be: clarity on where the care is provided; about the treatment process or outcome to achieve a particular health status; adequate information regarding their preferences; perceived credibility of the information source; clarity in the language used to describe options; attention to different attributes of a decision such as benefits and harms; number of options available; valuing of previous experiences in similar situations; affection; description of the effects in the order in which they occur; analysis of reliable opinions of others; perceived social norms; and media influence 6 .…”

mentioning

confidence: 99%

Fifteen minutes

Bernardo¹,

María²,

Salomão³

et al. 2014

Rev. Assoc. Med. Bras.

View full text Add to dashboard Cite

Describing the importance of obesity toDay, anD the lack of strategies for proper management, can take fifteen minutes of reaDing, but the problem must involve much more time of your attention, as well as guiDance to your patients. Epidemic and rising rates of obesity in many parts of the world are leading to increased suffering and economic stress. Despite decades of research on the causes of the obesity pandemic, which does not seem close to a solution, there is still no clear understanding of the nature of the problem. This limits creativity and suffocates expansive thinking, which could advance in the field of prevention and treatment, as well as in the scope of the complications of obesity. Shared decision-making and the redirecting of policies could remove barriers that prevent us from moving forward to solve an urgent public health issue of the beginning of this century 1.2 .Overweight and obesity reflect a gain of excess body fat, including visceral fat, which is a result of initially imperceptible cumulative effects of everyday eating, hourly, with no proper physical activity, creating a surplus of calories consumed in relation to those expended. Excess weight gain, gradual and unintended, is accompanied by the difficulty of reversing the picture and can become permanent. Even if all currently obese patients were treated effectively in the absence of adequate preventive efforts, there would still be continued growth in the number of obese people. Many multifaceted interventions to prevent obesity seek to influence the balance of calories, focusing on energy consumption, or energy expenditure. While obesity is a priority from an epidemiological and public health perspective, it becomes even more important as it influences other aspects of society. Substantial direct and indirect costs include discrimination, economic deprivation, loss of productivity and disability. Thus, state and local governments end up diverting resources for prevention and treatment. The country's health system is burdened with the comorbidities of obesity, such as type 2 diabetes, hypertension, cardiovascular diseases, osteoarthritis and cancer. It is estimated that the annual burden of obesity is almost 10% of all medical spending 3 .There are programs of shared decision-making that offer surgical treatment modalities for weight loss, including:Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding and laparoscopic sleeve gastrectomy. Patients attend seminars where they are instructed on the differences in outcomes, follow-up and complications of each procedure. The main information presented at the seminar include: 1. Greater weight loss with Roux-en-Y and sleeve gastrectomy compared to the use of a gastric band; 2. The gastric band requires the highest number of post-operative visits (monthly in the first year); 3. The Roux-en-Y and the sleeve gastrectomy have a higher rate of life-threatening complications than the gastric band (fistula); 4. The gastric band has highest number of delayed complications related to the ...

show abstract

What Is Shared in Shared Decision Making? Complex Decisions When the Evidence Is Unclear

Cited by 144 publications

References 71 publications

The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults

The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults

What Do Patients Want? Patient Preference in Wound Care

Fifteen minutes

Contact Info

Product

Resources

About