Shared decision-making as an existential journey: Aiming for restored autonomous capacity.

Area of Science:

• Medical Ethics
• Patient-Centered Care
• Psychosocial Aspects of Illness

Background:

• Illness poses profound existential challenges, affecting patients physically, socially, psychologically, and spiritually.
• The experience of illness often involves uncertainty and vulnerability, fundamentally altering a patient's state.

Purpose of the Study:

• To explore the existential dimensions of illness and their implications for shared decision-making.
• To broaden the understanding of shared decision-making by examining core relational concepts.

Main Methods:

• Analysis of core concepts in medical encounters: uncertainty, vulnerability, dependency, autonomy, power, and trust.
• Interpretation of existing results through an existential lens.

Main Results:

• Illness-induced uncertainty and vulnerability highlight the relational nature of patient autonomy.
• Power dynamics and trust significantly influence patient dependency within shared decision-making.
• Information overload can exacerbate patient uncertainty.

Conclusions:

• Shared decision-making (SDM) carries significant existential weight due to patient uncertainty, vulnerability, and power imbalances.
• Effective SDM necessitates greater attention to the emotional and relational aspects of care.
• The primary goal of SDM should be to restore a patient's autonomous capacity.