A shared treatment decision‐making approach between patients with chronic conditions and their clinicians: the case of diabetes
- 24 January 2006
- journal article
- case report
- Published by Wiley in Health Expectations
- Vol. 9 (1), 25-36
- https://doi.org/10.1111/j.1369-7625.2006.00359.x
Abstract
In this paper, we discuss the Charles et al. approach to shared treatment decision-making (STDM) as applied to patients with chronic conditions and their clinicians. We perceive differences between the type of treatment decisions (e.g. end-of-life care, surgical treatment of cancer) that generated existing approaches of shared decision-making for acute care conditions (including the Charles et al. model) and the treatment decisions that patients with chronic conditions need to make and revisit on an ongoing basis. For instance, treatment decisions in the chronic care setting are more likely to require a more active patient role in carrying out the decision and to offer a longer window of opportunity to make decisions and to revisit and reverse them without important loss than acute care decisions. The latter may require minimal patient participation to realize, are often urgent, and may be irreversible. Given these differences, we explore the applicability of the Charles et al. model of STDM in the chronic care context, especially chronic care that relies heavily on patient self-management (e.g. diabetes). To apply the Charles et al. model in this clinical context, we suggest the need to emphasize the patient-clinician relationship as one of partners in making difficult treatment choices and to add a new component to the shared decision-making approach: the need for an ongoing partnership between the clinical team (not just the clinician) and the patient. In the last section of the paper, we explore potential healthcare system barriers to STDM in chronic care delivery. Throughout the discussion we identify areas for further research.Keywords
This publication has 39 references indexed in Scilit:
- Self‐reported use of shared decision‐making among breast cancer specialists and perceived barriers and facilitators to implementing this approachHealth Expectations, 2004
- The Structure of Everyday Self-Care Decision Making in Chronic IllnessQualitative Health Research, 2003
- Shared Treatment Decision Making: What Does It Mean to Physicians?Journal of Clinical Oncology, 2003
- Differences between perspectives of physicians and patients on anticoagulation in patients with atrial fibrillation: observational study Commentary: Varied preferences reflect the reality of clinical practiceBMJ, 2001
- Lessons learned from the Decision Board: a unique and evolving decision aidHealth Expectations, 2000
- Clinical decision‐making in the context of chronic illnessHealth Expectations, 2000
- Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango)Social Science & Medicine, 1997
- The Role of Patient Participation in the Doctor Visit: Implications for adherence to diabetes careDiabetes Care, 1996
- Clinical decision making: from theory to practice. Anatomy of a decisionPublished by American Medical Association (AMA) ,1990
- Assessing the Effects of Physician-Patient Interactions on the Outcomes of Chronic DiseaseMedical Care, 1989