Clinical Medical Ethics and the Historical Background of Shared Decision Making

2021 ◽  
pp. 27-36
Author(s):  
Mark Siegler
Keyword(s):  
United States ◽  
Decision Making ◽  
Medical Ethics ◽  
Shared Decision Making ◽  
Clinical Medicine ◽  
The United States ◽  
Historical Background ◽  
Shared Decision ◽  
Truth Telling ◽  
Ethical Problems

In 1982, the concept of physician-patient accommodation was renamed shared decision making by the President’s Commission for the Study of Ethical Problems in Medicine. Since then, shared decision making has replaced thousands of years of paternalistic physician-controlled medicine and has emerged as the prevailing model of the doctor-patient relationship in the United States. The President’s Commission’s perspective was closely based on the development of clinical medical ethics (CME) in the early 1970s. CME addresses clinical issues such as truth telling, informed consent, confidentiality, and end-of-life care, and must be practiced by licensed clinicians in their routine, daily encounters with more than 40 million inpatients and about 1.5 billion outpatients in the United States each year. The central goal of CME is to improve the quality of patient care by identifying and contributing to the resolution of ethical problems in the practice of clinical medicine; this goal is frequently achieved by shared decision making.

scholarly journals Shared Decision Making and Patient-Centered Care in Israel, Jordan, and the United States: Exploratory and Comparative Survey Study of Physician Perceptions (Preprint)

2020 ◽  
Author(s):  
Yaara Zisman-Ilani ◽  
Rana Obeidat ◽  
Lauren Fang ◽  
Sarah Hsieh ◽  
Zackary Berger
Keyword(s):  
United States ◽  
Decision Making ◽  
Shared Decision Making ◽  
The United States ◽  
Patient Centered Care ◽  
Survey Study ◽  
Shared Decision ◽  
Patient Centered ◽  
Centered Care ◽  
Comparative Survey

BACKGROUND Shared decision making (SDM) is a health communication model that evolved in Europe and North America and largely reflects the values and medical practices dominant in these areas. OBJECTIVE This study aims to understand the beliefs, perceptions, and practices related to SDM and patient-centered care (PCC) of physicians in Israel, Jordan, and the United States. METHODS A hypothesis-generating comparative survey study was administered to physicians from Israel, Jordan, and the United States. RESULTS A total of 36 surveys were collected via snowball sampling (Jordan: n=15; United States: n=12; Israel: n=9). SDM was perceived as a way to inform patients and allow them to participate in their care. Barriers to implementing SDM varied based on place of origin; physicians in the United States mentioned limited time, physicians in Jordan reported that a lack of patient education limits SDM practices, and physicians in Israel reported lack of communication training. Most US physicians defined PCC as a practice for prioritizing patient preferences, whereas both Jordanian and Israeli physicians defined PCC as a holistic approach to care and to prioritizing patient needs. Barriers to implementing PCC, as seen by US physicians, were mostly centered on limited appointment time and insurance coverage. In Jordan and Israel, staff shortage and a lack of resources in the system were seen as major barriers to PCC implementation. CONCLUSIONS The study adds to the limited, yet important, literature on SDM and PCC in areas of the world outside the United States, Canada, Australia, and Western Europe. The study suggests that perceptions of PCC might widely differ among these regions, whereas concepts of SDM might be shared. Future work should clarify these differences.

scholarly journals Shared Decision-Making in Patients With Prostate Cancer in Japan: Patient Preferences Versus Physician Perceptions

2018 ◽  
pp. 1-9 ◽  
Author(s):  
Ulrike Schaede ◽  
Jörg Mahlich ◽  
Masahiko Nakayama ◽  
Hisanori Kobayashi ◽  
Yuriko Takahashi ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
United States ◽  
Decision Making ◽  
Shared Decision Making ◽  
Patient Preferences ◽  
Treatment Decision ◽  
Japanese Patients ◽  
The United States ◽  
Treatment Decisions ◽  
Shared Decision

This article adds the Japanese perspective to our knowledge of shared decision-making (SDM) preferences by surveying patients with prostate cancer (PCA) and physicians in Japan. In 2015, 103 Japanese patients with PCA were asked about their SDM preferences by using an Internet-based 5-point-scale questionnaire. Concurrently, 127 Japanese physicians were surveyed regarding their perceptions of patient preferences on SDM. Drivers of preferences and perceptions were analyzed using univariable ordinal logistic regression and graphing the fitted response probabilities. Although 41% of both patients and physicians expressed and expected a desire for active involvement in treatment decisions (a higher rate than in a similar study for the United States in 2001), almost half the Japanese patients preferred SDM, but only 33% of physicians assumed this was their choice. That is, 29% of Japanese physicians underestimated patients’ preference for involvement in making treatment decisions. Patients with lower health-related quality of life (as measured by the Functional Assessment of Cancer Therapy-Prostate [FACT-P]) expressed a stronger preference for SDM. The study shows that the worse the medical situation, the more patients with PCA prefer to be involved in the treatment decision, yet physicians tend to underestimate the preferences of their patients. Perhaps in contrast to common assumptions, Japanese patients are as interested in being involved in decision making as are patients in the United States.

scholarly journals Patient experiences of shared decision-making are associated with implantable cardioverter defibrillator recipients" openness to discuss device deactivation at end-of-life

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
OJ Oh ◽  
KS Lee ◽  
J Miller ◽  
M Hammash ◽  
DR Thompson ◽  
...  
Keyword(s):  
United States ◽  
Decision Making ◽  
End Of Life ◽  
Shared Decision Making ◽  
The United States ◽  
Public Institution ◽  
Shared Decision ◽  
Icd Implantation ◽  
Life Issues ◽  
End Of Life Issues

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): In Australia, this study received funding from a faculty grand by Australian University Faculty of Health Sciences Research grant. In the United States, the study was funded by a research professor award from University of Kentucky. Background. Shared decision-making is important for ICD recipients to fully contemplate and rationally decide about ICD deactivation at end-of-life. Although discussions about device deactivation at end-of-life are recommended to be held before ICD implantation and throughout the illness trajectory, such discussions rarely occur in clinical practice. Purpose. To identify whether ICD recipients’ experiences of end-of-life discussions with clinicians are associated with openness to discussing ICD deactivation at end-of-life. Methods. This cross-sectional study included 293 ICD recipients living in the United States, Australia, and South Korea (mean age 59, 22.5% female, mean ICD implantation 10 years). Hierarchical logistic regression was used to determine whether patients’ experiences of shared decision-making were associated with openness to discuss device deactivation at end-of-life after controlling for relevant covariates (i.e. age, gender, ICD implantation years, ICD shock experience, general ICD experience, ICD knowledge, and concerns related to the ICD). Results. About half of the participants (57.7%) were open to discussing ICD deactivation at end-of-life with clinicians. Almost one-quarter (23.5%) had no prior experience of discussing any end-of-life issues with clinicians. Patients’ past experiences of end-of-life discussions with clinicians were significantly associated with openness to discuss device deactivation at end-of-life (OR: 1.30) after adjusting for covariates. Conclusion. Our results highlight that clinicians’ willingness to discuss sensitive end-of-life issues such as battery replacement and deactivation of defibrillation therapy empowers patients to actively engage in end-of-life discussions.

Shared decision making in the United States: policy and implementation activity on multiple fronts

2011 ◽  
Vol 105 (4) ◽  
pp. 305-312 ◽  
Author(s):  
Dominick L. Frosch ◽  
Benjamin W. Moulton ◽  
Richard M. Wexler ◽  
Margaret Holmes-Rovner ◽  
Robert J. Volk ◽  
...  
Keyword(s):  
United States ◽  
Decision Making ◽  
Shared Decision Making ◽  
The United States ◽  
Shared Decision ◽  
United States Policy ◽  
Implementation Activity

scholarly journals Using CollaboRATE, a brief patient-reported measure of shared decision making: Results from three clinical settings in the United States

2017 ◽  
Vol 21 (1) ◽  
pp. 82-89 ◽  
Author(s):  
Rachel C. Forcino ◽  
Paul J. Barr ◽  
A. James O'Malley ◽  
Roger Arend ◽  
Molly G. Castaldo ◽  
...  
Keyword(s):  
United States ◽  
Decision Making ◽  
Shared Decision Making ◽  
The United States ◽  
Clinical Settings ◽  
Shared Decision ◽  
Patient Reported

scholarly journals Shared Decision Making and Patient-Centered Care in Israel, Jordan, and the United States: Exploratory and Comparative Survey Study of Physician Perceptions

10.2196/18223 ◽  
2020 ◽  
Vol 4 (8) ◽  
pp. e18223
Author(s):  
Yaara Zisman-Ilani ◽  
Rana Obeidat ◽  
Lauren Fang ◽  
Sarah Hsieh ◽  
Zackary Berger
Keyword(s):  
United States ◽  
Decision Making ◽  
Shared Decision Making ◽  
The United States ◽  
Patient Centered Care ◽  
Survey Study ◽  
Shared Decision ◽  
Patient Centered ◽  
Centered Care ◽  
Comparative Survey

Background Shared decision making (SDM) is a health communication model that evolved in Europe and North America and largely reflects the values and medical practices dominant in these areas. Objective This study aims to understand the beliefs, perceptions, and practices related to SDM and patient-centered care (PCC) of physicians in Israel, Jordan, and the United States. Methods A hypothesis-generating comparative survey study was administered to physicians from Israel, Jordan, and the United States. Results A total of 36 surveys were collected via snowball sampling (Jordan: n=15; United States: n=12; Israel: n=9). SDM was perceived as a way to inform patients and allow them to participate in their care. Barriers to implementing SDM varied based on place of origin; physicians in the United States mentioned limited time, physicians in Jordan reported that a lack of patient education limits SDM practices, and physicians in Israel reported lack of communication training. Most US physicians defined PCC as a practice for prioritizing patient preferences, whereas both Jordanian and Israeli physicians defined PCC as a holistic approach to care and to prioritizing patient needs. Barriers to implementing PCC, as seen by US physicians, were mostly centered on limited appointment time and insurance coverage. In Jordan and Israel, staff shortage and a lack of resources in the system were seen as major barriers to PCC implementation. Conclusions The study adds to the limited, yet important, literature on SDM and PCC in areas of the world outside the United States, Canada, Australia, and Western Europe. The study suggests that perceptions of PCC might widely differ among these regions, whereas concepts of SDM might be shared. Future work should clarify these differences.

scholarly journals Recent Patterns in Shared Decision Making for Prostate-Specific Antigen Testing in the United States

2018 ◽  
Vol 16 (2) ◽  
pp. 139-144 ◽  
Author(s):  
Stacey A. Fedewa ◽  
Ted Gansler ◽  
Robert Smith ◽  
Ann Goding Sauer ◽  
Richard Wender ◽  
...  
Keyword(s):  
United States ◽  
Decision Making ◽  
Prostate Specific Antigen ◽  
Shared Decision Making ◽  
Specific Antigen ◽  
The United States ◽  
Shared Decision ◽  
Prostate Specific Antigen Testing ◽  
Antigen Testing
Sign in / Sign up

Export Citation Format

Share Document