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      Consideration of Shared Decision Making in Nursing: A Review of Clinicians’ Perceptions and Interventions

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          Abstract

          As the number of individuals with chronic illness increases so has the need for strategies to enable nurses to engage them effectively in daily management of their conditions. Shared decision making between patients and nurses is one approach frequently discussed in the literature. This paper reviews recent studies of shared decision making and the meaning of findings for the nurse-patient relationship. Patients likely to prefer to engage in shared decision making are younger and have higher levels of education. However, there is a lack of evidence for the effect of shared decision making on patient outcomes. Further, studies are needed to examine shared decision making when the patient is a child. Nurses are professionally suited to engage their patients fully in treatment plans. More evidence for how shared decision making affects outcomes and how nurses can successfully achieve such engagement is needed.

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          An integrative model of shared decision making in medical encounters.

          Gregory Makoul, Marla L. Clayman (2006)
          Given the fluidity with which the term shared decision making (SDM) is used in teaching, assessment and research, we conducted a focused and systematic review of articles that specifically address SDM to determine the range of conceptual definitions. In April 2005, we ran a Pubmed (Medline) search to identify articles published through 31 December 2003 with the words shared decision making in the title or abstract. The search yielded 681 citations, 342 of which were about SDM in the context of physician-patient encounters and published in English. We read and reviewed the full text of all 342 articles, and got any non-redundant references to SDM, which yielded an additional 76 articles. Of the 418 articles examined, 161 (38.5%) had a conceptual definition of SDM. We identified 31 separate concepts used to explicate SDM, but only "patient values/preferences" (67.1%) and "options" (50.9%) appeared in more than half the 161 definitions. Relatively few articles explicitly recognized and integrated previous work. Our review reveals that there is no shared definition of SDM. We propose a definition that integrates the extant literature base and outlines essential elements that must be present for patients and providers to engage in the process of SDM. The integrative definition of SDM is intended to provide a useful foundation for describing and operationalizing SDM in further research.
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            Do people want to be autonomous patients? Preferred roles in treatment decision-making in several patient populations.

            Raisa B Deber, Nancy Kraetschmer, Sara Urowitz … (2007)
            What role do people want to play in treatment decision-making (DM)? Examine the role patients indicate they would prefer in making treatment decisions across multiple clinical settings in Ontario, Canada. Secondary analysis of a series of survey/interview-based studies measuring preferred role, conducted in 12 different populations. Respondents were outpatients, largely but not entirely attending outpatient clinics in large teaching hospitals in urban settings in the Province of Ontario, Canada. The subgroups and sample sizes were: breast cancer (202), prostate disease (202), fractures (202), continence (46), orthopaedic (111), rheumatology (56), multiple sclerosis (22), HIV/AIDS (431), infertility (454), benign prostatic hyperplasia (678) and cardiac disease (300), plus 50 healthy nursing students (for scale validation). All studies categorized preferred role using the Problem-Solving Decision-Making (PSDM) scale with one or both of the Current Health condition and Chest Pain vignettes. Few respondents preferred an autonomous role (1.2% for the current health condition vignette and 0.7% for the chest pain vignette); most preferred shared DM (77.8% current health condition; 65.1% chest pain) or a passive role (20.3% current health condition; 34.1% chest pain). Familiarity with a clinical condition increases desire for a shared (as opposed to passive) role. Preferences for passive vs. shared roles varied across settings; older and less educated individuals were most likely to prefer passive roles. Despite consumerist rhetoric among some bioethicists, very few respondents wish an autonomous role. Most wish to share DM with their providers.
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              Desire for information and involvement in treatment decisions: elderly cancer patients' preferences and their physicians' perceptions.

              Deborah Schrag, Elena Elkin, Ephraim Casper … (2007)
              Shared decision making is a tenet of contemporary medicine and oncology practice. How involved elderly patients want to be in making treatment decisions and how physicians perceive patient preferences for such involvement are uncertain. In structured interviews about multiple facets of chemotherapy treatment decision making, we asked patients age 70 years and older with a recent diagnosis of metastatic colorectal cancer (CRC) about their preferences for prognostic information and for involvement in treatment decision making. We also asked treating oncologists (n = 19) to describe their perceptions of patient preferences. Information and decision-making preferences were evaluated in relation to sociodemographic and clinical characteristics. Seventy-three patients age 70 to 89 years completed the study interview within 16 weeks of metastatic CRC diagnosis. Most patients (n = 70; 96%) had decided to receive chemotherapy and 61 had initiated treatment. Relatively few (n = 32; 44%) wanted information about expected survival when they made a treatment decision. Preference for prognostic information was more common among men than women (56% v 29%; P < .05). About half of the patients (n = 38; 52%) preferred a passive role in the treatment decision-making process. Physician perceptions were concordant with patient preferences for information in 44% of patient-physician pairs and for decision control in 41% of patient-physician pairs. For older patients with advanced CRC, preferences for prognostic information and for an active role in treatment decision making are not easily predictable. Physicians' perceptions are often inconsistent with patients' stated preferences. Explicit discussion of preferred decision-making styles may improve patient-physician encounters.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Open Nurs J
                Journal ID (publisher-id): TONURSJ
                Title: The Open Nursing Journal
                Publisher: Bentham Open
                ISSN (Electronic): 1874-4346
                Publication date (Electronic): 2 October 2009
                Publication date Collection: 2009
                Volume: 3
                Pages: 65-75
                Affiliations
                [1 ]Center for Managing Chronic Disease, University of Michigan, 109 Observatory, Ann Arbor, MI 48109-2029, USA
                [2 ]Center for Managing Chronic Disease, University of Michigan, 109 Observatory, Ann Arbor, Michigan 48109-2029, USA
                [3 ]Health Behavior & Health Education, University of Michigan School of Public Health, 109 Observatory, Ann Arbor, Michigan 48109-2029, USA
                [4 ]Center for Managing Chronic Disease, University of Michigan, 109 Observatory, Ann Arbor, Michigan 48109-2029, USA
                [5 ]National Respiratory Training Center, Division of Research & Community Health, P.O Box 5468, Suffolk, VA 23435, USA
                [6 ]National Respiratory Training Center Virginia/Education for Health, The Athenaeum, 10 Church Street, Warwick, CV34 4AB, UK
                Author notes
                [* ]Address correspondence to this author at the Center for Managing Chronic Disease, University of Michigan, 109 Observatory, Ann Arbor, MI 48109-2029, USA; Tel: (734) 763-1457; Fax: (734) 763-9115; E-mail: nmclark@ 123456umich.edu
                Article
                Publisher ID: TONURSJ-3-65
                DOI: 10.2174/1874434600903010065
                PMC ID: 2765030
                PubMed ID: 19855848
                SO-VID: 927de66d-2793-43e2-bf85-8a056218f8b2
                Copyright © © Clark et al.; Licensee Bentham Open.
                License:

                This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

                History
                Date received : 3 June 2009
                Date revision received : 4 September 2009
                Date accepted : 4 September 2009
                Categories
                Subject: Article

                ScienceOpen disciplines: Nursing
                Keywords: patient-clinician collaboration,clinical role preference.,patient-clinician communication,shared decision making,nurse-patient relationship
                Data availability:
                ScienceOpen disciplines: Nursing
                Keywords: patient-clinician collaboration, clinical role preference., patient-clinician communication, shared decision making, nurse-patient relationship

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