This largely theoretical article describes the balance between two medical decision making principles – beneficence and autonomy – and the growing shift towards a model of an autonomous, informed and participatory patient. The article proposes that shared decision making (SDM) strikes a balance between beneficence and autonomy and thus it should be adopted more widely. The authors review policy options for implanting SDM more widely through practice models, state policy incentives, and federal requirements. The article provides some detailed examples from health systems and states that have implemented SDM through the above models, and proposes a three-step process for implementing a nationwide practice of SDM.
This article provides details of a study that found that using a decision aid in conjunction with shared decision making offered protection for physicians against a malpractice ruling in a mock trial. Focus groups representing potential jurors were presented with a case where a man was sued after being diagnosed with prostate cancer following an earlier decision not to obtain a Prostate Specific Antigen (PSA) test due to his physician’s advice. When potential jurors in focus groups were told the physician showed the patient a video decision aid for a PSA test, 94% felt the standard of care had been met and only 4% felt harm had been caused. This offered significant protection compared to only a note in the medical record, where 72% of potential jurors felt the standard of care had been met and 23% felt harm had been caused.