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potentially preference sensitive, implying that physicians should always consider the
patient’s perspective, even in cases of decisions about issues that may appear value-
neutral at first glance [10].
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1.3. Shared decision making (SDM)
Modern-day health care practice offers people an increasing amount of healthcare
options, from preconception to end-of-life care. Advances in medical knowledge and
health innovation have also resulted in increasingly complex decisions regarding
personal health. Most (if not all) of us face some through personal health choices
throughout our life courses. Not only do (preference-sensitive) medical decisions often
involve high-stakes and trade-offs between potential benefits and harms of different
options (such as between quantity and quality of life, or between treatment efficacy and
treatment burden), as patients we also often face emotionally charged, unanticipated and
novel situations. To optimize personal health choices, new information needs to be
integrated with personal values, life goals and circumstances.
People vary widely in how they value the matters at stake in trade-offs. For each
individual patient, the suitability of each of the medical treatment options depends on the
individual patient’s unique values, preferences and circumstances. This makes it
essential to involve patients in the decisions that concern their life and well-being, as
patients also indicate themselves – about 80% of people want to be actively involved in
the medical decision-making process involving invasive medical procedures [11].
Another example that illustrates the need for more active patient engagement in treatment
decision making comes from a recent study in the Netherlands, which revealed that one
in three prostate cancer patients was dissatisfied with the amount of information they
received about their treatment options [12]. Shared decision making is not only aimed at
physical health, but also applies to mental health [13].
SDM is often characterized as a meeting between two experts: A medical and an
existential expert. The medical expert, that is, the healthcare provider, can bring in
professional expertise, such as information about the medical condition from which a
patient is suffering, the medical treatment options for which a patient is eligible and the
evidence about the pros and cons associated with those options, according to available
medical evidence and the healthcare provider’s own expertise. The existential expert,
that is, the patient (and in some cases, such as in aged care, also their loved ones), can
bring in information about his or her unique circumstances, personal values and (life)
goals, which are essential for interpreting the medical evidence in light of what matters
most from the patient’s perspective. Even if a patient does not want to make a final
decision, SDM can help a health care provider to make a decision that is sensitive to the
patient’s values and context. The ideal of SDM has been called “the pinnacle of patient-
centered care” [14]. However, despite SDM being embraced as the gold standard, its
implementation is lagging behind and health care practice still widely deviates from this
norm. For example, in a study published in 2012, less than 50% of patients reported that
their healthcare providers had considered their personal goals or concerns [15].
M.deVriesetal. /FosteringSharedDecisionMakingwithHealth Informatics Interventions 113
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book Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners"
Applied Interdisciplinary Theory in Health Informatics
Knowledge Base for Practitioners
- Title
- Applied Interdisciplinary Theory in Health Informatics
- Subtitle
- Knowledge Base for Practitioners
- Authors
- Philip Scott
- Nicolette de Keizer
- Andrew Georgiou
- Publisher
- IOS Press BV
- Location
- Amsterdam
- Date
- 2019
- Language
- English
- License
- CC BY-NC 4.0
- ISBN
- 978-1-61499-991-1
- Size
- 16.0 x 24.0 cm
- Pages
- 242
- Category
- Informatik