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abstract:
A patient in the clinic; a person in the world. Why shared decision making needs to center on the person rather than the medical encounter - Patient Education and Counseling
Interest
in shared decision making (SDM) has increased and become widely
promoted. However, from both practical and measurement perspectives,
SDM’s origin as an outgrowth of patient autonomy has resulted in
narrowly conceptualizing and operationalizing decision making. The
narrow focus on individual patient autonomy fails in four main ways: 1)
excluding several facets of the roles, actions, and influences of
decision partners in decision making; 2) focusing solely on the medical
encounter; 3) ignoring the informational environment to which patients
have access; and 4) treating each encounter as independent of all
others. In addition to creating a research agenda that could answer
important outstanding questions about how decisions are made and the
consequences thereof, reconceiving SDM as centered on the person rather
than the medical encounter has the potential to transform how illness is
experienced by patients and families and how clinicians find meaning in
their work.
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