scholarly journals Montgomery and shared decision-making: implications for good psychiatric practice

2018 ◽  
Vol 213 (5) ◽  
pp. 630-632 ◽  
Author(s):  
Gwen Adshead ◽  
David Crepaz-Keay ◽  
Mayura Deshpande ◽  
K.W.M (Bill) Fulford ◽  
Veryan Richards
Keyword(s):  
Decision Making ◽  
Medical Treatment ◽  
Supreme Court ◽  
Shared Decision Making ◽  
Best Practice ◽  
Psychiatric Care ◽  
Psychiatric Practice ◽  
Health Board ◽  
Shared Decision ◽  
Consent To Medical Treatment

SummaryThe 2015 Supreme Court judgment in Montgomery v Lanarkshire Health Board [2015] UKSC 11 established that consent to medical treatment requires shared decision-making based on dialogue between the clinician and patient. In this editorial, we examine what Montgomery means for standards of good psychiatric practice, and argue that it represents an opportunity for delivering best practice in psychiatric care.Declaration of interestNone.

Shared decision making and consent post-Montgomery, UK Supreme Court judgement supporting best practice

2020 ◽  
Vol 103 (12) ◽  
pp. 2609-2612
Author(s):  
Joel Ward ◽  
Dilraj Kalsi ◽  
Anirudh Chandrashekar ◽  
Bill Fulford ◽  
Regent Lee ◽  
...  
Keyword(s):  
Decision Making ◽  
Supreme Court ◽  
Shared Decision Making ◽  
Best Practice ◽  
Shared Decision ◽  
Uk Supreme Court

Certified Patient Decision Aids: Solving Persistent Problems with Informed Consent Law

2017 ◽  
Vol 45 (1) ◽  
pp. 12-40 ◽  
Author(s):  
Thaddeus Mason Pope
Keyword(s):  
Decision Making ◽  
Informed Consent ◽  
Medical Treatment ◽  
Shared Decision Making ◽  
Decision Aids ◽  
Shared Decision ◽  
Legal Doctrine ◽  
Patient Decision Aids ◽  
Patient Decision ◽  
Decision Making Processes

The legal doctrine of informed consent has overwhelmingly failed to assure that the medical treatment patients get is the treatment patients want. This Article describes and defends an ongoing shift toward shared decision making processes incorporating the use of certified patient decision aids.

scholarly journals Computer knows best? The need for value-flexibility in medical AI

2018 ◽  
Vol 45 (3) ◽  
pp. 156-160 ◽  
Author(s):  
Rosalind J McDougall
Keyword(s):  
Decision Making ◽  
Medical Treatment ◽  
Shared Decision Making ◽  
Patient Autonomy ◽  
Ethical Issues ◽  
Treatment Decision ◽  
Shared Decision ◽  
Treatment Decision Making ◽  
Value Judgements ◽  
The Relationship

Artificial intelligence (AI) is increasingly being developed for use in medicine, including for diagnosis and in treatment decision making. The use of AI in medical treatment raises many ethical issues that are yet to be explored in depth by bioethicists. In this paper, I focus specifically on the relationship between the ethical ideal of shared decision making and AI systems that generate treatment recommendations, using the example of IBM’s Watson for Oncology. I argue that use of this type of system creates both important risks and significant opportunities for promoting shared decision making. If value judgements are fixed and covert in AI systems, then we risk a shift back to more paternalistic medical care. However, if designed and used in an ethically informed way, AI could offer a potentially powerful way of supporting shared decision making. It could be used to incorporate explicit value reflection, promoting patient autonomy. In the context of medical treatment, we need value-flexible AI that can both respond to the values and treatment goals of individual patients and support clinicians to engage in shared decision making.

scholarly journals Engaging Multidisciplinary Stakeholders to Drive Shared Decision-Making in Oncology

2018 ◽  
Vol 34 (1) ◽  
pp. 29-31 ◽  
Author(s):  
Gabrielle Rocque ◽  
Ellen Miller-Sonnet ◽  
Alan Balch ◽  
Carrie Stricker ◽  
Josh Seidman ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Best Practices ◽  
Shared Decision Making ◽  
Best Practice ◽  
Care Delivery ◽  
Evidence Based ◽  
Shared Decision ◽  
Oncology Practice ◽  
Development And Validation

Although recognized as best practice, regular integration of shared decision-making (SDM) approaches between patients and oncologists remains an elusive goal. It is clear that usable, feasible, and practical tools are needed to drive increased SDM in oncology. To address this goal, we convened a multidisciplinary collaborative inclusive of experts across the health-care delivery ecosystem to identify key principles in designing and testing processes to promote SDM in routine oncology practice. In this commentary, we describe 3 best practices for addressing challenges associated with implementing SDM that emerged from a multidisciplinary collaborative: (1) engagement of diverse stakeholders who have interest in SDM, (2) development and validation of an evidence-based SDM tool grounded within an established conceptual framework, and (3) development of the necessary roadmap and consideration of the infrastructure needed for engendering patient engagement in decision-making. We believe these 3 principles are critical to the success of creating SDM tools to be utilized both within and outside of clinical practice. We are optimistic that shared use across settings will support adoption of this tool and overcome barriers to implementing SDM within busy clinical workflows. Ultimately, we hope that this work will offer new perspectives on what is important to patients and provide an important impetus for leveraging patient preferences and values in decision-making.

scholarly journals Perioperative shared decision-making in the Bay of Plenty, New Zealand: Audit results from a complex decision pathway quality improvement initiative using a structured communication tool

2020 ◽  
Vol 48 (6) ◽  
pp. 473-476
Author(s):  
Heidi C Omundsen ◽  
Renee L Franklin ◽  
Vicki L Higson ◽  
Mark S Omundsen ◽  
Jeremy I Rossaak
Keyword(s):  
Decision Making ◽  
New Zealand ◽  
Shared Decision Making ◽  
Elective Surgery ◽  
Quality Improvement Initiative ◽  
Health Board ◽  
Shared Decision ◽  
Communication Tool ◽  
Complex Decision ◽  
Structured Communication

Patients presenting for elective surgery in the Bay of Plenty area in New Zealand are increasingly elderly with significant medical comorbidities. For these patients the risk–benefit balance of undergoing surgery can be complex. We recognised the need for a robust shared decision-making pathway within our perioperative medicine service. We describe the setup of a complex decision pathway within our district health board and report on the audit data from our first 49 patients. The complex decision pathway encourages surgeons to identify high-risk patients who will benefit from shared decision-making, manages input from multiple specialists as needed with excellent communication between those specialists, and provides a patient-centred approach to decision-making using a structured communication tool.

To what extent psychiatric patients feel involved in decision making about their mental health care? Relationships with socio-demographic, clinical, and psychological variables

2013 ◽  
Vol 26 (6) ◽  
pp. 372-381 ◽  
Author(s):  
Carlos De las Cuevas ◽  
Wenceslao Peñate
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Self Efficacy ◽  
Psychiatric Care ◽  
Psychiatric Patients ◽  
Shared Decision ◽  
Psychiatric Outpatients ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Care Relationships

BackgroundShared decision making (SDM) is an essential component of patient-centered care, but there is little information about its use in the psychiatric care.ObjectiveTo measure to what extent psychiatric patients feel they were involved in the process and steps of decision making about treatment choice and to analyse the influence of socio-demographic, clinical, and psychological processes on this perception.MethodsCross-sectional survey involving 1100 consecutive psychiatric outpatients invited to complete the nine-item Shared Decision-Making Questionnaire (SDM-Q-9), health locus of control and control preferences, self-efficacy and drug attitude scales, as well as a questionnaire including socio-demographic and clinical variables.ResultsA high response rate of 77% was registered, resulting in a sample of 846 psychiatric outpatients. SDM-Q-9 total score indicate a moderately low degree of perceived participation, with differing perceived implementation of the individual the SDM process steps. Patient diagnosis evidenced significant differences in SDM perception. Patients’ perception of SDM was explained by four main variables: the older the patient, the lower self-reported SDM; having a diagnosis of schizophrenia increases the likelihood of lower SDM; a positive attitude towards psychiatric drugs favors greater SDM, as well as a higher level of self-efficacy.ConclusionThe result of this study suggests that SDM is currently not widely practiced in psychiatric care. Further research is needed to examine if the low level of participation self-reported is justified by psychiatric patients’ decisional capacity.

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