Why shared decision making is not good enough: lessons from patients

Abstract

A closer look at the lived illness experiences of medical professionals themselves shows that shared decision making is in need of a logic of care. This paper underlines that medical decision making inevitably takes place in a messy and uncertain context in which sharing responsibilities may impose a considerable burden on patients. A better understanding of patients' lived experiences enables healthcare professionals to attune to what individual patients deem important in their lives.This will contribute to making medical decisions in a good and caring manner, taking into account the lived experience of being ill.

How shared is shared decision-making? A care-ethical view on the role of partner and family

“…However, research shows that SDM is a practice full of tensions. The ideal and the practice are often wide apart, the practice is often complex and participants experience it very differently 1 2. In this complex practice, the ‘third party’ of the partner and the family may be experienced as an extra complicating factor,6–9 even if their participation and contribution are welcome in principal 10 11.…”

“…Although shared decision-making (SDM) is not yet a common practice in health or palliative care, empirical research shows that patient groups benefit from SDM 1 2. Including the patient as a participant in the decision-making process is vital for good care, on legal grounds and from a care-ethical perspective 1 2.…”

“…Including the patient as a participant in the decision-making process is vital for good care, on legal grounds and from a care-ethical perspective 1 2. For patients are legally entitled to decide about their lives and bodies, but since care ethics views care as a relational practice, a decision about good care for a particular patient can only come about in a relational attuning process.…”

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

“…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). Even for patients who are well informed and have high health literacy, shared decision making can sometimes impose an unrealistic burden on patients (Olthuis et al 2014).…”

Person-Centered Healthcare - moving from rhetoric to methods, through implementation to outcomes

“…This rise in 'patients as sovereign consumers of healthcare services' has by no means been welcomed by all and there are legitimate concerns for the implications of the new dynamic on the symmetry of the clinician-patient relationship and the characteristics of future healthcare services delivery [17][18][19][20][21][22][23][24][25][26]. While patients continue to be exercised by problems in the efficiency of clinical services, such as access and waiting times, one recurring complaint relates more to quality than quantity.…”