Shared decision-making: Meet patients where they need you

Although providers have been moving away from the paternalistic model of healthcare--in which patients relied heavily on their doctors' advice and then followed it--patients don't want the pendulum to swing entirely in the opposite direction either.

For example, out of 8,308 hospitalized patients at the University of Chicago, 97 percent surveyed said they wanted doctors to offer them choices and consider their opinions. But when it came to making the final medical decision, 67 percent preferred that their doctors take control.

The study, published in the Journal of Medical Ethics, indicates that patients want the most guidance when there is no obvious best choice, especially when the stakes are high. As noted in a New York Times blog post about the study, the burden of having a potentially life-or-death situation left up to patients and family members can often make a stressful situation worse. "If a physician with all of his or her clinical experience is feeling that much uncertainty, imagine what kind of serious anxiety and confusion the patient and family may be feeling," noted study coauthor Dr. Farr A. Curlin, an associate professor of medicine at the University of Chicago.

When it comes to treating non-life-threatening conditions, however, a separate study indicates that most patients want to be treated more like consumers. For this research, published in the Journal of Bone and Joint Surgery, researchers found that most of the 78 carpal tunnel surgery patients surveyed preferred and were more satisfied with a more active role in decision making.

Patients who were most likely to be highly involved in medical decisions were those who had undergone one or more previous surgical procedures, had a caregiver, or had additional private insurance to help defray treatment costs, according to researchers.

Resting between the extremes of the paternalistic and consumerist models, of course, is shared decision-making. With this approach, patients maintain their voice and preserve autonomy, while the physician shares in the decision-making responsibility.

To learn more:
- read the post from the New York Times
- see the study abstract from the Journal of Medical Ethics
- check out this article from Medical News Today