Treatment Decision Making and Its Discontents

Abstract

Patient participation in treatment decision making is held as a virtue in clinical contexts, and has much to recommend it. Yet important questions have been raised about the assumptions underlying models of patient participation. Debates have arisen about the significance of medically defined risks and outcomes of treatment; the adequacy and relevance across social groups of the concept of autonomy; and the emphasis on the professional-patient dyad. This article contributes to the debate about treatment decision making with reference to a study focused on older women with cancer. Interviews with patients and cancer care professionals highlighted the salience to patients' treatment choices of experiential knowledge, social roles and responsibilities, and the health policy context. It appears that prevailing models of decision making may obscure patients' more typical decision processes as well as the social determinants of those choices.

A Concept Analysis of Patient-Centered Care

“…SDM becomes another major concept in an effort to define PCC. As such, it refers to treatment choices by patients that take into account health condition knowledge, experiential knowledge, patient preference, and/or social responsibilities (Muller-Engelmann, Keller, Donner-Banzhoff, & Krones, 2010;Sinding & Wiernikowski, 2009). SDM is implemented while respecting the patient's ultimate goals and implementing a caring attitude (Fine, 2010;Frampton & Guastello, 2010;Jacob, 2010;Robinson et al, 2008).…”

Elders and patient participation revisited – a discourse analytic approach to older persons’ reflections on patient participation

“…2002). Others have focused on prevailing rationalities as an explanation of low levels of participation among old persons (Sinding & Wierrnikowski 2009, Efraimsson et al. 2004).…”

Shared Decision Making in Health Care Settings: A Role for Social Work

“…While client self-determination is at the basis of SDM, social workers must also engage in acquiring resources for patients and influencing policy that limits the treatment options available to them. In a study detailing the decision-making process of older women with cancer, Sinding and Wiernikowski (2009) "highlighted the salience to patients' treatment choices of experiential knowledge, social roles and responsibilities, and the health policy context" (p. 614). Vernberg (1998) argues that the models of medical decision making are too limited using a linear decision making process.…”