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Implementing shared decision-making: consider all the consequences.

Glyn Elwyn1, Dominick L Frosch2,3, Sarah Kobrin4

  • 1The Dartmouth Institute for Health Policy and Clinical Practice, 37 Dewey Field Road, Hanover, NH, 03755, USA. glynelwyn@gmail.com.

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Summary
This summary is machine-generated.

Shared decision-making (SDM) requires broader evaluation beyond short-term patient outcomes. Considering interactional, team, organizational, and system levels can reveal long-term benefits like safer, cost-effective healthcare.

Keywords:
Collaborative deliberationConceptual modelImplementationMeasurementMultilevelPatient-centered carePractice improvementQuality improvementShared decision making

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Area of Science:

  • Healthcare organization and delivery
  • Health services research
  • Clinical practice improvement

Background:

  • Current evaluation of shared decision-making (SDM) focuses on short-term patient outcomes.
  • Practice change in healthcare is influenced by cost, profit, quality, and efficiency, not just ethics or evidence.
  • A broader, long-term perspective on SDM consequences is needed for multiple stakeholders.

Purpose of the Study:

  • To hypothesize a wider set of long-term consequences of SDM at multiple levels (interactional, team, organizational, system).
  • To encourage future research on these broader SDM impacts.
  • To address the limited focus on clinician impact and short-term outcomes in current SDM research.

Main Methods:

  • Conceptual framework development for hypothesizing SDM consequences.
  • Literature review and synthesis of existing SDM outcome measures.
  • Longitudinal and multi-level analysis of potential SDM impacts.

Main Results:

  • Potential long-term consequences include cultural shifts towards deliberation and collaboration.
  • Organizational benefits may include improved patient experience and reduced legal challenges.
  • System-level impacts could involve changes in resource utilization, cost reduction, and workforce composition.

Conclusions:

  • A broader conceptualization and measurement of SDM are crucial for guiding implementation.
  • Well-informed, preference-based patient decisions can lead to safer, more cost-effective healthcare.
  • Routine SDM implementation may result in reduced utilization and improved health outcomes.