[Foundations of shared decision making and examples of its application in rehabilitation]

Enhanced patient participation in health care is demanded due to better knowledge of patients about diseases and their treatment, due to more treatment strategies in the course of scientific progress, due to ethical and legal considerations, and due to study results. With shared decision-making (SDM) a method was defined for the medical interview to involve patients in treatment decisions. Process steps for orientation are available for the procedure of the medical encounter. Transfer of shared decision-making into health care can be realized through three strategies, i. e., by physician training to enhance physicians' competencies in medical encounter, by decision aids for better information and preparation for decision making, and by patient education. For examination and fostering of SDM in German health care the German Ministry of Health initiated a research consortium in the years 2001 to 2007 called "Patient as a partner in medical decision making". In an additional research consortium of the German Ministry of Education and Research, the German Pension Insurance scheme as well as the associations of statutory and private health insurance, various projects for health services research on the subject of "Chronic Diseases and Patient Orientation" will be funded starting in 2008. This initiative with a focus on rehabilitation will foster studies about need-specific patient information, training programmes for chronically ill patients, and about the organisation of a more participative structure of health care delivery.