Shared decision-making in health care
When the first edition of this book came out in 2001 (under the title Evidence-based Patient Choice: Inevitable or Impossible?), it examined the emerging themes of patient choice and clinical decision-making, and looked at how these might develop in the future. Since then, these issues have become even more topical. Evidence-based medicine is deeply ingrained in the practice of modern medicine, whilst patient choice is increasingly high on the political agenda. But can the two
trends co-exist? 'Shared decision-making' has developed in response to the sometimes uneasy relationship between a patient's right to have input into their treatment options, and a clinician's responsibility to provide the best evidence-based health care.
Imagine a patient with osteoarthritis of the knee. She and her doctor are considering whether she would benefit from surgery to replace her knee joint. This sort of decision is typical of many in health care where there is more than one reasonable alternative available to the patient and her doctor. These alternatives include surgery, physiotherapy, medication, complementary remedies, and more. What is right for one patient may be different from what is right for another. Clinical information
(such as results of x-rays or even patient-reported symptom scores), though necessary, is not sufficient to determine the best treatment. Most importantly, each patient feels differently about the impact of the illness in their life and the importance of the potential good and bad outcomes of the
treatment options. In these situations, the best treatment is the one that reflects what is most important to patients who are well-informed about the options and potential outcomes. The shared decision-making approach helps doctors and patients to decide on the appropriate treatment.
This timely book explores shared decision-making by examining from practical and theoretical perspectives what should be part of the decision-making process, what the benefits and potential difficulties are when it is attempted, and examples of how this is achieved in real health care practice for several health conditions. Finally, it also examines how this type of health care is likely to become more common place in the future.