Shared treatment decision-making and the use of decision-aids

Over the past fifteen years or so, shared decision-making, a specific approach to making decisions in the medical encounter, has received considerable conceptual and practical attention among physicians, social scientists, and ethicists. In addition, governments and professional associations in different countries are developing patient charters/bills of rights to promote responsiveness to, and involvement of, patients in treatment decision-making. This widespread interest in shared decision-making derives from changes in ethical and legal notions of patient rights and is reflected in the language we now use to convey these: for example, patient rights of informed choice in treatment decision-making, rather than the more limited concept of informed consent. The former is a stronger message, encompassing broader principles of patient autonomy, control, patient challenge to physician authority, and patient participation in treatment decision-making. This chapter defines shared treatment decision-making and compares it to two other models: the paternalistic model and the informed model. It also discusses clinical contexts for partnership relationships and the use of treatment decision-aids as a means to implement shared decision-making.