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.
With any surgery, consent must be obtained from each patient, and valid consent is based on knowledge of the options, the risks and benefits of each option, and the likelihood that these will occur for the individual patients. The legal doctrine and requirements of informed consent are well known. In theory, informed consent is a process, not a moment in time. In reality, it has occurred when a clinician requests a signature from a patient to authorize that a specific treatment or procedure take place, and the patient signs. In current practice, there is no requirement that shared decision-making occur before the signing of the consent form.
Posted in Patient Decision Aids, Patient Involvement, Patient Preferences, SDM Implementation
Tagged consent form, Dartmouth-Hitchcock Medical Center, decision aids, decision-making, informed consent, informed decisions, informed patient choice, Medicare, patient-centered care, patients, shared decision making, surgery