Power imbalance prevents shared decision making

  title={Power imbalance prevents shared decision making},
  author={Natalie Joseph-Williams and Adrian G. K. Edwards and Glyn Elwyn},
  journal={BMJ : British Medical Journal},
Providing information is not enough to enable shared decision making, argue Natalie Joseph-Williams and colleagues. Action is required to change the attitudes of both patients and doctors 

Implementing shared decision making in the NHS: lessons from the MAGIC programme

Shared decision making requires a shift in attitudes at all levels but can become part of routine practice with the right support, say Natalie Joseph-Williams and colleagues

“What would you recommend doctor?”—Discourse analysis of a moment of dissonance when sharing decisions in clinical consultations

This work states that a common patient‐reported barrier is feeling that “doctor knows best”; thus, patients often defer decisions to the clinician.

Decision aids to prepare patients for shared decision making: Two randomized controlled experiments on the impact of awareness of preference‐sensitivity and personal motives

The potential of decision aids (DAs) in preparing patients for SDM by raising awareness of preference‐sensitivity and showing possible personal motives for decision making in addition to providing information about the treatment options is investigated.

A working partnership: A review of shared decision‐making in nephrology

This review article highlights the broad range and context of decisions faced by patients in several areas of nephrology care and discusses patient‐important outcomes, priorities and motivations that underpin their decision‐making.

Weight bias among health care professionals: A systematic review and meta‐analysis

Weight‐biased attitudes and views held by health care professionals can have a negative impact on the patient‐provider relationship and the provision of care, but studies have found mixed results

Patient views on asthma diagnosis and how a clinical decision support system could help: A qualitative study

  • A. CannyE. Donaghy L. Daines
  • Medicine
    Health expectations : an international journal of public participation in health care and health policy
  • 2022
A clinical decision support system for use in primary care including a patient‐facing mode, could change how information is shared between patients and healthcare professionals and improve the diagnostic process.

Re-engineering shared decision-making

A re-engineered model is proposed in which physicians elicit and prioritise patients’ goals of care and then help translate those goals into treatment options, after clarifying the patient's underlying health status.

Lessons in Integrating Shared Decision-Making Into Cancer Care.

Denmark's Lillebaelt Hospital has learned key lessons in implementing SDM so that the organization's culture is actually being transformed, and SDM is becoming part of the fabric of care, not a mere add-on to it.

The role of medical schools in promoting social accountability through shared decision-making

To increase the implementation of shared decision-making practices in Israel, an official policy needs to be established to encourage the investment of resources towards helping educators, researchers, and practitioners translate and integrate it into daily practice.

Health Literacy and Shared Decision-making: Exploring the Relationship to Enable Meaningful Patient Engagement in Healthcare

An expanded model of shared decision-making is proposed which incorporates health literacy concepts and promotes two-tiered intervention methods to improve the targeting and personalization of communication and support the development of transferable health literacy skills among patients.



Consumers’ views of quality in the consultation and their relevance to ‘shared decision‐making’ approaches

This paper presents a meta-analysis of evidence of ‘effectiveness’ of shared decision‐making and other communication interventions in eight countries over a 12-month period and shows clear patterns of decline in the effects of these interventions on quality and satisfaction.

Developing and evaluating complex interventions: the new Medical Research Council guidance

The Medical Research Council's evaluation framework (2000) brought welcome clarity to the task and now the council has updated its guidance.

Patchy ‘coherence’: using normalization process theory to evaluate a multi-faceted shared decision making implementation program (MAGIC)

The study showed that implementation of shared decision making is more complex than the delivery of patient decision support interventions to patients, a portrayal that often goes unquestioned.

Authoritarian physicians and patients' fear of being labeled 'difficult' among key obstacles to shared decision making.

It is argued that physicians may not be aware of a need to create a safe environment for open communication to facilitate shared decision making and that Rigorous measures of patient engagement, and of the degree to which health care decisions truly reflect patient preferences, are needed to advance shared decisionMaking in clinical practice.

Shared Decision Making: A Model for Clinical Practice

A model of how to do shared decision making that is based on choice, option and decision talk is proposed that is practical, easy to remember, and can act as a guide to skill development.

Encouraging patients to ask questions: how to overcome "white-coat silence".

Patient engagement is unproven and potentially inappropriate as a safety net for catching medical errors, but it may be a valuable tool for facilitating communication that empowers patients and presents suggestions for how they may be overcome.

Decision aids for people facing health treatment or screening decisions.

Tests indicate that decision aids improve knowledge and realistic expectations; enhance active participation in decision making; lower decisional conflict; decrease the proportion of people remaining undecided, and improve agreement between values and choice.

Improving the quality of decision making in breast cancer: consultation planning template and consultation recording template.

Two templates that can be used to improve the quality of breast cancer treatment decisions are described, which are practical tools that nurses can use to help patients make better decisions.