Shared Decision Making in Medicine

Kajnar, Hana

doi:10.1007/978-0-387-33921-4_10

Cited by 1 publication

(2 citation statements)

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“…The need for explicitation of problem framing and goal‐setting as a key starting point of the process, however, seems to be new, and could help to better describe the whole process. It would also require to moving some key components, such as the elicitation of preferences and values, from the stage of the intervention to the very beginning of the process, greatly facilitating the integration with the principles of patient‐centredness, narrative medicine, value‐based medicine and shared‐decision making [10,36,38,39]. This essay does not address the issue of decision making, which is currently at the centre of the EBM debate [11,12].…”

Section: Discussionmentioning

confidence: 99%

“…Similar constructs can be built for other combinations, such as in the self-interested case, when the action of the (bad) practitioner is directed by personal interests (such as prescribing a drug from a company offering an inducement), and still the effects of the treatment can be either matched or unmatched with the patient's goal. The distinction between a paternalistic and a shared-decision approach is not secondary, because a shared choice, in addition to a greater respect for the ethical principle of autonomy [33], is likely to be associated with greater satisfaction, better adherence and, eventually, better outcome [36]. Of course, this requires the involvement of the patient from the early stages of the process [10].…”

Section: Goal-settingmentioning

confidence: 99%

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Epistemology and ethics of evidence‐based medicine: putting goal‐setting in the right place

Sestini

2010

Evaluation Clinical Practice

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While evidence-based medicine (EBM) is often accused on relying on a paradigm of 'absolute truth', it is in fact highly consistent with Karl Popper's criterion of demarcation through falsification. Even more relevant, the first three steps of the EBM process are closely patterned on Popper's evolutionary approach of objective knowledge: (1) recognition of a problem; (2) generation of solutions; and (3) selection of the best solution. This places the step 1 of the EBM process (building an answerable question) in a pivotal position for the understanding of the whole process, and underscores a few aspects which are often overlooked in EBM courses. First in this step internal evidence (including personal expertise) must be appraised and integrated in the problem. Second, issues of applicability of the possible solution should be anticipated. Third, and possibly more important, the goal of the intervention should be set at this stage (typically by choosing the outcome in a PICO question). Depending whether or not goals depend on the goals of others, and whether they concern others' voluntary behaviour, goals may be classified as self-serving, moral, altruistic or moralistic. Thus, delicate ethical questions must be addressed at this stage, which means that patient preferences and values must be carefully sought, so that empathy, counselling and narrative medicine must be mastered to be able to formulate correctly an answerable question. The need to modify the current description of the EBM process to increase the recognition of implicit assumptions and increase the consistency of this model is discussed.

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Section: Discussionmentioning

confidence: 99%