Reconciling the theory and reality of shared decision‐making: A “matching” approach to practitioner leadership

Abstract Shared decision making (SDM) evolved to resolve tension between patients’ entitlement to make health‐care decisions and practitioners’ responsibility to protect patients’ interests. Implicitly assuming that patients are willing and able to make “good” decisions, SDM proponents suggest that...

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Main Authors: Stephen L. Brown, Peter Salmon
Format: Article
Language:English
Published: Wiley 2019-06-01
Series:Health Expectations
Subjects:
Online Access:https://doi.org/10.1111/hex.12853
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spelling doaj-d700d2d043014d099a48b62b07cbc5532020-11-25T02:16:02ZengWileyHealth Expectations1369-65131369-76252019-06-0122327528310.1111/hex.12853Reconciling the theory and reality of shared decision‐making: A “matching” approach to practitioner leadershipStephen L. Brown0Peter Salmon1Department of Psychological Sciences University of Liverpool Liverpool UKDepartment of Psychological Sciences University of Liverpool Liverpool UKAbstract Shared decision making (SDM) evolved to resolve tension between patients’ entitlement to make health‐care decisions and practitioners’ responsibility to protect patients’ interests. Implicitly assuming that patients are willing and able to make “good” decisions, SDM proponents suggest that patients and practitioners negotiate decisions. In practice, patients often do not wish to participate in decisions, or cannot make good decisions. Consequently, practitioners sometimes lead decision making, but doing so risks the paternalism that SDM is intended to avoid. We argue that practitioners should take leadership when patients cannot make good decisions, but practitioners will need to know: (a) when good decisions are not being made; and (b) how to intervene appropriately and proportionately when patients cannot make good decisions. Regarding (a), patients rarely make decisions using formal decision logic, but rely on informal propositions about risks and benefits. As propositions are idiographic and their meanings context‐dependent, normative standards of decision quality cannot be imposed. Practitioners must assess decision quality by making subjective and contextualized judgements as to the “reasonableness” of the underlying propositions. Regarding (b), matched to judgements of reasonableness, we describe levels of leadership distinguished according to how directively practitioners act; ranging from prompting patients to question unreasonable propositions or consider new propositions, to directive leadership whereby practitioners recommend options or deny requested procedures. In the context of ideas of relational autonomy, the objective of practitioner leadership is to protect patients’ autonomy by supporting good decision making, taking leadership in patients’ interests only when patients are unwilling or unable to make good decisions.https://doi.org/10.1111/hex.12853cancerclinical communicationleadershippatient‐practitioner relationshipshared decision making
collection DOAJ
language English
format Article
sources DOAJ
author Stephen L. Brown
Peter Salmon
spellingShingle Stephen L. Brown
Peter Salmon
Reconciling the theory and reality of shared decision‐making: A “matching” approach to practitioner leadership
Health Expectations
cancer
clinical communication
leadership
patient‐practitioner relationship
shared decision making
author_facet Stephen L. Brown
Peter Salmon
author_sort Stephen L. Brown
title Reconciling the theory and reality of shared decision‐making: A “matching” approach to practitioner leadership
title_short Reconciling the theory and reality of shared decision‐making: A “matching” approach to practitioner leadership
title_full Reconciling the theory and reality of shared decision‐making: A “matching” approach to practitioner leadership
title_fullStr Reconciling the theory and reality of shared decision‐making: A “matching” approach to practitioner leadership
title_full_unstemmed Reconciling the theory and reality of shared decision‐making: A “matching” approach to practitioner leadership
title_sort reconciling the theory and reality of shared decision‐making: a “matching” approach to practitioner leadership
publisher Wiley
series Health Expectations
issn 1369-6513
1369-7625
publishDate 2019-06-01
description Abstract Shared decision making (SDM) evolved to resolve tension between patients’ entitlement to make health‐care decisions and practitioners’ responsibility to protect patients’ interests. Implicitly assuming that patients are willing and able to make “good” decisions, SDM proponents suggest that patients and practitioners negotiate decisions. In practice, patients often do not wish to participate in decisions, or cannot make good decisions. Consequently, practitioners sometimes lead decision making, but doing so risks the paternalism that SDM is intended to avoid. We argue that practitioners should take leadership when patients cannot make good decisions, but practitioners will need to know: (a) when good decisions are not being made; and (b) how to intervene appropriately and proportionately when patients cannot make good decisions. Regarding (a), patients rarely make decisions using formal decision logic, but rely on informal propositions about risks and benefits. As propositions are idiographic and their meanings context‐dependent, normative standards of decision quality cannot be imposed. Practitioners must assess decision quality by making subjective and contextualized judgements as to the “reasonableness” of the underlying propositions. Regarding (b), matched to judgements of reasonableness, we describe levels of leadership distinguished according to how directively practitioners act; ranging from prompting patients to question unreasonable propositions or consider new propositions, to directive leadership whereby practitioners recommend options or deny requested procedures. In the context of ideas of relational autonomy, the objective of practitioner leadership is to protect patients’ autonomy by supporting good decision making, taking leadership in patients’ interests only when patients are unwilling or unable to make good decisions.
topic cancer
clinical communication
leadership
patient‐practitioner relationship
shared decision making
url https://doi.org/10.1111/hex.12853
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