Shared decision-making in medicine

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Almario et al. found rather high patient-reported scores of physicians' interpersonal skills (DISQ, ~89 of 100) and SDM (SDM-Q-9, ~79–100) with no significant differences between trial arms. Slatore et al. showed that lower patient reported quality of communication was associated with higher odds of patient distress but not with patients' perceived involvement in decision-making. Tai-Seale et al. used one item on physician respect (CAHPS) and found similarly positive evaluations reported by 91–99% of participants in each of the four study arms. Observed SDM scores were between 67 and 75% (CollaboRATE, top scores reported). Jouni et al. assessed both patient self-report experiences with health care (CAHPS, six items) and self-reported and observed SDM. They documented high observed and self-reported SDM scores (OPTIONS, ~71 of 100 and SDM-Q, ~10.5 of 11) and high rates of positive responses to CAHPS questions (>97% of patients responded positively). Harter et al. also used both patient self-report measures and third-party observer measures. They reported an empathy score of ~44 of 50 (CARE) in both control and intervention arms, and SDM scores of ~73 of 100 in both arms (SDM-Q-9), and ~21 vs ~27 of 100 for control and intervention arm (OPTION12).

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interprofessional shared decision-making (IP-SDM) model is a three-level, two-axis framework that takes this complexity into account. Its three levels are contextual influences at the individual level, influences at the systemic or organizational level, and influences at the broader policy or social level. The axes are the SDM process (vertical) and the different people involved (horizontal). While interacting with one or more health professionals and family members, the patient moves through a structured process including explanation of the decision to be made; information exchange; eliciting values and preferences; discussing the feasibility of the options; the preferred choice versus the decision made; planning and implementing the decisions; and outcomes. Since this model was validated in 2011, it has been adopted in rehabilitation, dementia care, mental health, neonatal intensive care, hospital chaplaincy and educational research, among other fields.

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educated and have less severe illnesses than other patients are more likely to participate in medical decisions. That is, more education appears to increase participation levels and old age to reduce it. Another study found that age was not inversely related to participation levels but that patients who are not as fluent with numbers and statistics tended to let their physicians make medical decisions. Culture also makes a difference. In general, for example, Americans play a more active role in the physician-patient relationship, such as by asking follow-up questions and researching treatment options, than do Germans. In one study, Black patients reported that they participate less in shared decision-making than white patients, yet another study showed that Black patients desire to participate just as much as their white counterparts and are more likely to report initiating conversation about their health care with their physicians.

281:. The model recognizes that patients have personal values that influence the interpretation of risks and benefits differently from the way a physician interprets them. Informed consent is at the core of shared decision-making, i.e. without fully understanding the advantages and disadvantages of all treatment options, patients cannot engage in making decisions. But there is frequently more than one option, with no clear choice of which option is best, especially when the decision at hand is about a preference-sensitive condition. Shared decision-making differs from informed consent in that patients base their decisions on their values and beliefs, as well as on being fully informed. Thus in certain situations the physician's point of view may differ from the decision that aligns most with the patient's values, judgments, opinions, or expectations about outcomes. 565:

professional teams involved in caring for an elderly person who may have several health problems at once. Some researchers, for example, are focussing on how interprofessional teams might practise shared decision-making among themselves and with their patients. Researchers are also expanding the definition of shared decision-making to include an ill person's spouse, family caregivers or friends, especially if they are responsible for giving the person medicine, transporting them or paying the bills. Decisions that ignore them may not be based on realistic options or may not be followed through. Shared decision-making is also now being applied in areas of healthcare that have wider social implications, such as decisions faced by the frail elderly and their caregivers about staying at home or moving into care facilities.

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health-related questions the patient asks along with the number of times the patient asks the physician to verify information (e.g. asking a physician to repeat information or summarizing what the physician said to ensure the information was understood). The second component is assertive utterances. e.g. making recommendations to physicians, expressing an opinion or preference, or expressing disagreement. The third component is providing information about symptoms, medical history and psychosocial factors, with or without prompting from the physician. The final component of patient participation is expressions of concern, including affective responses such as anxiety, worry, or negative feelings. The extent of participation can be determined based on how often a patient displays these four overarching behaviors.

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scales is to explore what happens in shared decision-making and how much it happens, with the goal of applying this knowledge to incite healthcare professionals to practise it. Based on these scales, simple tools are being designed to help physicians better understand their patients' decision needs. One such tool that has been validated, SURE, is a quick questionnaire for finding out in busy clinics which patients are not comfortable about the treatment decision (decisional conflict). SURE is based on O'Connor's Decisional Conflict Scale which is commonly used to evaluate patient decision aids. The four yes-or-no questions are about being

392:(MCDA) methods. The first report of ISPOR's (International Society for Pharmacoeconomics and Outcomes Research) MCDA Emerging Good Practices Task Force identifies SDM as supported by MCDA. The second ISPOR report by the same group states the following regarding the state of the art of MCDA use in health care: "The use of MCDA in health care is in its infancy, and so any good practice guidelines can only be considered "emerging" at this point... Although it is possible to identify good practices that should inform the use of MCDA in health care, inevitably this endeavor would benefit from further research." 518:

without me" a reality. The Shared Decision-Making programme is part of the Quality Improvement Productivity and Prevention (QIPP) Right Care programme. In 2012, the programme entered an exciting new phase and, through three workstreams, is aiming to embed the practice of shared decision-making among patients and those who support them, and among health professionals and their educators. One of the components of the National Programme is the work of the Advancing Quality Alliance (AQuA), who are tasked with creating a receptive culture for shared decision-making with patients and health professionals.

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revealed that SDM description, clarification and recommendations in CPGs and CSs concerning breast cancer treatment were poor, leaving a large scope for improvement in this area. Although SDM was more frequently reported in CPGs and CSs in recent years, SDM was less often covered in medical journals. SDM should be suitably described and promoted in the future, and specific tools should be implemented to appraise its dealing and promotion in specific cancer CPGs and CSs. Medical journals should play a decisive role in supporting SDM in CPGs and CSs they publish in the future.

385:, has published a set of standards, representing the efforts of more than 100 participants from 14 countries around the world to will help determine the quality of patient decision aids. The IPDAS standards assist patients and health practitioners to assess the content, development process, and effectiveness of decision aids. According to IPDAS, certified decision aids should, for example, provide information about options, present probabilities of outcomes, and include methods for clarifying patients' values. 505:

medical licensing bodies). An ongoing inventory of existing programs shows that they vary widely in what they deliver and are rarely evaluated. These observations led to an international effort to list and prioritize the skills necessary for practising shared decision-making. Discussion about what core competencies should be taught and how they should be measured returned to basic questions: what exactly is shared decision-making, do decisions always have to be shared, and how can it be accurately evaluated?

253:, which he attributed to varying physician practice styles. A key means of reducing this unwarranted variation was to recognise "the importance of sound estimates of outcome probabilities and on values that corresponded closely to patient preferences". Shared decision-making would allow patient preferences and values to determine the right rate of healthcare use. The Dartmouth Institute for Health Policy and Clinical Practice consequently made shared decision-making a key element of their program of work. 301:

involved in the quality of their care, such as following up on abnormal test results and determining when to seek care. Providing patients with ready access to their doctors' visit notes has proven to have a positive impact on the doctor-patient relationship, enhancing patient trust, safety and engagement. Patients with access to notes also show greater interest in taking a more active role in the generation of their medical records. The adoption of open notes has recently been recommended by the

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patient, an interaction with an overconfident and overly-assertive medical professional, and general structural deficits in care that may undermine opportunities for a patient to exert control over the situation. Additional barriers to SDM may include a lack of insurance coverage or understanding it, lack of knowledge or challenges with organizational priorities related to conditions, and lack of clarity with

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dissatisfaction. Critics of the SDM model assert that physicians who choose not to question and challenge the assumptions of patients do a medical disservice to patients, who are overall less knowledgeable and skilled than the physician. Physicians who encourage patient participation can help the patient make a decision that is aligned with the patients' values and preferences. For those who are designing a

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frameworks. Some countries in South America and south-east Asia have also introduced related policies. The rationale for these new policies ranges from respect for consumer or patient rights to more utilitarian arguments such as that shared decision-making could help control health care costs. However, in general the gap between political aspirations and practical reality is still yawning.

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and their family. Second, the clinician introduces the options in a clear way, describing and explaining the probabilities of benefits and harms that might be likely—this is option talk. In the last phase, patients' preferences are constructed, elicited and integrated—this is decision talk. A shorter five-item version of the OPTION scale has been published based on this model.

625:(QIs) focused on the evaluation of SDM. However, a recent Spanish study about quality indicators showed that there is no consensus concerning breast cancer care quality indicators and standards of care even in the same country. A wider systematic review about worldwide QIs in breast cancer have demonstrated that more than half of countries have not established a national 327:

best course of action, leading to c) providing information about the attributes of available options and d) supporting a deliberation process. Based on these steps, an assessment scale to measure the extent to which clinicians involve patients in decision-making has been developed (the OPTION scale) and translated into Dutch, Chinese, French, German, Spanish and Italian.

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preferences. Interactive software or internet websites have also been designed to facilitate shared decision-making. Research has shown that the use of decision aids may increase patients' trust in physicians, thereby facilitating the shared decision-making process. Many research and implementation studies on decision aids (up to 2010) are contained in the book

474:) is a process in which both the patient and physician contribute to the medical decision-making process and agree on treatment decisions. Health care providers explain treatments and alternatives to patients and help them choose the treatment option that best aligns with their preferences as well as their unique cultural and personal beliefs. 208:) is a process in which both the patient and physician contribute to the medical decision-making process and agree on treatment decisions. Health care providers explain treatments and alternatives to patients and help them choose the treatment option that best aligns with their preferences as well as their unique cultural and personal beliefs. 400:

another attribute. Additive models may lead to counter-intuitive scenarios where a treatment that is associated with high quality of life but a very short life expectancy, may turn out to be recommended as a better choice than a treatment which is associated with moderately less quality of life but much longer life expectancy.

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behaviors (like reading the risks about a new treatment), and disease-specific management strategies. In a similar vein, a recent study found that among patients with diabetes, the more an individual remembers information given by a physician, the more the patient participated in self-care behaviors at home.

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The aim of the NHS RightCare Shared Decision-Making Programme in England is to embed shared decision-making in NHS care. This is part of the wider ambition to promote patient-centred care, to increase patient choice, autonomy and involvement in clinical decision-making and make "no decision about me,

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Decision aids that answer this test with a "Yes" should not be considered for life-critical SDM because they may lead to unintended outcomes. Note that a "No" answer is a necessary, but not sufficient, condition for consideration. MCDA models also need to realistically reflect individual preferences.

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Individuals who place a higher value on their health are more likely to play a passive role when it comes to medical decision-making than those who placed a lower value on health. Researchers Arora and McHorney posit that finding may be the result of their apprehension when it comes to health-related

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Some patients do not find the SDM model to be the best approach to care. A qualitative study found that barriers to SDM may include a patient's desire to avoid participation from lack of perceived control over the situation, a medical professional's inability to make an emotional connection with the

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The EMPAThiE study defined an empowered patient as a patient who "... has control over the management of their condition in daily life. They take action to improve the quality of their life and have the necessary knowledge, skills, attitudes and self-awareness to adjust their behavior and to work in

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Patient empowerment enables patients to take an active role in the decisions made about their own healthcare. Patient empowerment requires patients to take responsibility for aspects of care such as respectful communications with their doctors and other providers, patient safety, evidence gathering,

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Researchers in shared decision-making are increasingly taking account of the fact that involvement in making healthcare decisions is not always limited to one patient and one healthcare professional in a clinical setting. Often more than one healthcare professional is involved in a decision, such as

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While there are numerous approaches for involving patients in using decision aids, involving them in the design and development of these tools, from the needs assessment, to reviewing the content development, through the prototyping, piloting, and usability testing, will overall benefit the process.

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Another model proposes three different "talk" phases: team talk, option talk and decision talk. First, clinicians work to create a supportive relationship with the patient as they introduce the idea of recognizing the existence of alternative actions (options)—this is to form a team with the patient

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Elwyn et al. described a set of competences for shared decision-making, consisting of the following steps a) defining the problem which requires a decision, b) the portrayal of equipoise (meaning that clinically speaking there is little to choose between the treatments) and the uncertainty about the

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Generally, physicians engage in more patient-centered communication when they are speaking with high-participation patients rather than with low-participation patients. Also, when a patient consults with a physician of the same race, the patient perceives that physician as involving them more than a

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brings together "xperts in health communication, health literacy, shared decision-making, and related fields come together to ... offer insight into how state-of-the-art advances in medical science can be transformed into state-of-the-art clinical decision making and improved health communication."

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Charles et al. described a set of characteristics of shared decision-making, stating "that at least two participants, the clinician and patient be involved; that both parties share information; that both parties take steps to build a consensus about the preferred treatment; and that an agreement is

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began a series with a session focused on "The Greatest Untapped Resource in Healthcare? Informing and Involving Patients in Decisions about Their Medical Care." Powerful conclusions emerged among the 58 participants from 18 countries: not only is it ethically right that patients should be involved

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Several researchers in this field have designed scales for measuring to what extent shared decision-making takes place in the clinical encounter and its effects, from the perspective of patients or healthcare professionals or both, or from the perspective of outside observers. The purpose of these

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In recognition of a growing consensus that there is an ethical imperative for health care professionals to share important decisions with patients, several countries in Europe, North America and Australia have formally recognized shared decision-making in their health policies and regulatory

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There is currently limited evidence to form a robust conclusion that involving older patients with multiple health conditions in decision-making during primary care consultations has benefits. Examples of patient involvement in decision-making about their health care include patient workshops and

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in patients, which in turn, leads to better health outcomes. When a patient participates more in the decision-making process, the frequency of self-management behaviors increases, as well. Self-management behaviors fall into three broad categories: health behaviors (like exercise), consumeristic

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communication by physicians has led to facilitating greater patient engagement. In the context of mammography screening, physicians' message delivery styles such as how they articulated relative versus absolute risk numbers had also influenced patients' perceptions towards shared decision-making.

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For those who do participate in decision-making, there are potential disadvantages. As patients take part in the decision process, physicians may communicate uncertain or unknown evidence about the risks and benefits of a decision. The communication of scientific uncertainty may lead to decision

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Providing patients with personal coronary risk information may assist patients in improving cholesterol levels. Such findings are most likely attributed to an improvement in self-management techniques in response to the personalized feedback from physicians. Additionally, the findings of another

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Training health professionals in shared decision-making attracts the attention of policy makers when it shows potential for addressing chronic problems in healthcare systems such as the overuse of drugs or screening tests. One such program, designed for primary care physicians in Quebec, Canada,

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is a field related to shared decision-making but which focuses more specifically on the patient's role in the patient-physician relationship. There are certain patient characteristics that influence the extent of their participation. One study showed that female patients who are younger and more

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than before. For example, a 2007 review of 115 patient participation studies found that the majority of respondents preferred to participate in medical decision-making in only 50% of studies prior to 2000, while 71% of studies after 2000 found a majority of respondents who wanted to participate.

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A recent study stated that the main obstacle to use SDM in clinical practice indicated for practitioners was the lack of time and resources. It is poorly reflected in clinical practice guidelines and consensus and barriers to its implementation persist. It has been already demonstrated that new

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In a systematic review of patient-provider communication published in 2018, "Humanistic communication in the evaluation of shared decision making", the authors reported, "Five other studies reported scores on humanistic aspects of conversation, and scores of SDM, without reporting associations.

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Another related measure scores patient-doctor encounters using three components of patient-centered communication: the physician's ability to conceptualize illness and disease in relation to a patient's life; to explore the full context of the patient's life setting (e.g. work, social supports,

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Harvey Fineberg, head of the US Institute of Medicine, has suggested that shared decision-making should be shaped by the particular needs and preferences of the patient, which may be to call on a physician to assume full responsibility for decisions or, at the other extreme, to be supported and

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While some medical schools (e.g. in Germany, the Netherlands, UK and Canada) already include such training programs in their residency programs, there is increasing demand for shared decision-making training programs by medical schools and providers of continuing professional education (such as

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SDM, or making it happen. Based on studies of barriers to shared decision-making as perceived by health professionals and patients, many researchers are developing sound, theory-based training programs and decision aids, and evaluating their results. Canada has established a research chair that

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A prime example is the case of decision aids for life-critical SDM. The use of additive MCDA models for life-critical shared decision-making is misleading because additive models are compensatory in nature. That is, good performance on one attribute can compensate for the poor performance on

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There is mounting evidence that giving patients real-time, unfettered access to their own medical records increases their understanding of their health and improves their ability to take care of themselves. Study results indicate that full record access enables patients to become more actively

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The study of SDM quality and reporting in clinical practice guidelines (CPGs) and consensus statements (CSs) have been inadequately addressed. There is a tool for evaluating quality and reporting of SDM in guidance documents based on the AGREE II statement and RIGHT instrument. A recent study

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in assisting the patients to choose the best treatment option. Patient decision aids, which may be leaflets, video or audio tapes, or interactive media, supplement the patient-physician relationship and assist patients in making medical decisions that most closely align with their values and

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A study of surgical consultations found that opportunities for shared decision-making were limited for life-saving surgeries. Patients and their families saw the surgeon's role as fixing the problem and, regardless of whether they had surgery, they tended to accept the decision made. Shared

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Other studies have shown that the strongest predictors of patient participation are not characteristics of the patients themselves but are specific to the situation, such as the clinical setting and the physician's style of communicating. Frequent use of partnership-building and supportive

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Measures of patient participation can also be used to measure aspects of shared decision-making. The ecological model of patient participation, based on research by Street, includes four main components of patient participation. The first is information seeking, measured as the number of

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More and more care is delivered not by individuals but by interprofessional healthcare teams that include nurses, social workers, and other care providers. In these settings, patients' health care decisions are shared with several professionals, whether concurrently or consecutively. The

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and tool support. Furthermore, dispositional factors may play an important role in the extent to which a patient feels comfortable with a participating in medical decisions. Individuals who exhibit high trait anxiety, for example, prefer not to participate in medical decision-making.

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A recent study found that individuals who participate in shared decision-making are more likely to feel secure and may feel a stronger sense of commitment to recover. Also, research has shown that SDM leads to higher judgments of the quality of care. Furthermore, SDM leads to greater

439:) concept. Their model passes the reasonableness test. The model selects the treatment that is associated with the maximum quality-adjusted life expectancy (QALE) defined as the product of life expectancy under a treatment multiplied by the average health utility value. 509:

guided by the physician to make completely autonomous decisions. This suggests that, just as with interventions, which need to match the patient's style and preferences, patient's preferences for degree of involvement also need to be taken into account and respected.

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President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, 1982. Making Health Care Decisions. The Ethical and Legal Implications of Informed Consent in the Patient-Practitioner Relationship. Washington, 1982. Page

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or integrated breast cancer care process to achieve excellence in breast cancer care. There was heterogeneity in QIs for the evaluation of breast cancer care quality. Quality indicators that focus on primary care, patient satisfaction, and SDM are scarce.

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Maes-Carballo, M.; Munoz-Nunez, I.; Martin-Diaz, M.; Mignini, L.; Bueno-Cavanillas, A.; Khan, K.S. Shared decision making in breast cancer treatment guidelines: Development of a quality assessment tool and a systematic review. Health Expect. 2020, 23,

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Grover SA, Lowensteyn I, Joseph L, Kaouache M, Marchand S, Coupal L, et al. (November 2007). "Patient knowledge of coronary risk profile improves the effectiveness of dyslipidemia therapy: the CHECK-UP study: a randomized controlled trial".

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The subject of designing the appropriate decision aids for SDM is a crucial one in SDM and thus it requires more work by the scientific and practitioners' communities in order to become mature and thus enable SDM to reach its full potential.

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Maes-Carballo, M.; Martín-Díaz, M.; Mignini, L.; Khan, K.S.; Trigueros, R.; Bueno-Cavanillas, A. Evaluation of the Use of Shared Decision Making in Breast Cancer: International Survey. Int. J. Environ. Res. Public Health 2021, 18, 2128.

713:(ISDM) Conference, which have been held at Oxford (2001), Swansea (2003), Ottawa (2005), Freiburg (2007), Boston (2009), Maastricht (2011), Lima (2013), Sydney (2015), Lyon (2017), Quebec City (2019), and Kolding, Denmark (2022). 589:

on 2 March 2002 aimed for a "health democracy" in which patients' rights and responsibilities were revisited, and it gave patients an opportunity to take control of their health. Similar laws have been passed in countries such as

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reached on the treatment to implement". This final element is not fully accepted by everyone in the field. The view that it is acceptable to agree to disagree is also regarded as an acceptable outcome of shared decision-making.

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Unfortunately, most of the MCDA models used today in health care were developed for non-medical applications. This has led to many instances of misuse of MCDA models in health care and in shared decision-making in particular.

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Much of the literature seems to assume that achieving shared decision-making is a matter of giving healthcare professionals enough information. Some attempts are being made to empower and educate patients to expect it.

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Frosch DL, Bhatnagar V, Tally S, Hamori CJ, Kaplan RM (February 2008). "Internet patient decision support: a randomized controlled trial comparing alternative approaches for men considering prostate cancer screening".

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Garvelink MM, Groen-van de Ven L, Smits C, Franken R, Dassen-Vernooij M, Légaré F (September 2019). "Shared Decision Making About Housing Transitions for Persons With Dementia: A Four-Case Care Network Perspective".

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by Robert Veatch in 1972. It was used again in 1982 in the "President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research". This work built on the increasing interest in

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Légaré F, Ratté S, Gravel K, Graham ID (December 2008). "Barriers and facilitators to implementing shared decision-making in clinical practice: update of a systematic review of health professionals' perceptions".

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The average health utility value is the sum of the products of the probabilities of having adverse effects under the particular treatment times the health utility value under the corresponding adverse effect(s).

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The above considerations have motivated Kujawski, Triantaphyllou and Yanase to introduce their "reasonableness test" for the case of life-critical SDM. Their reasonableness test asks the following key question:

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more closely in decisions about their own medical care and the risks involved, it is practical – through careful presentation of information and the use of decision aids/pathways – and it brings down costs.

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showed that shared decision-making can reduce use of antibiotics for acute respiratory problems (earaches, sinusitis, bronchitis, etc.) which are often caused by viruses and do not respond to antibiotics.

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and an increasing emphasis on recognising patient autonomy in health care interactions since the 1970s. Some would even claim that a general paradigm shift occurred in the 1980s in which patients became

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Kunneman M, Gionfriddo MR, Toloza FJ, Gärtner FR, Spencer-Bonilla G, Hargraves IG, et al. (March 2019). "Humanistic communication in the evaluation of shared decision making: A systematic review".

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Butler AM, Elkins S, Kowalkowski M, Raphael JL (February 2015). "Shared decision making among parents of children with mental health conditions compared to children with chronic physical conditions".

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Jeanne Wirpsa M, Emily Johnson R, Bieler J, Boyken L, Pugliese K, Rosencrans E, et al. (2018-10-15). "Interprofessional Models for Shared Decision Making: The Role of the Health Care Chaplain".

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study indicate that the use of a cardiovascular risk calculator led to increased patient participation and satisfaction with the treatment decision process and outcome and reduced decisional regret.

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placed physicians in a position of authority with patients playing a passive role in care. Physicians instructed patients about what to do, and patients rarely took part in the treatment decision.

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Vortel MA, Adam S, Port-Thompson AV, Friedman JM, Grande SW, Birch PH (October 2016). "Comparing the ability of OPTION(12) and OPTION(5) to assess shared decision-making in genetic counselling".

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Dunn SI, Cragg B, Graham ID, Medves J, Gaboury I (May 2018). "Roles, processes, and outcomes of interprofessional shared decision-making in a neonatal intensive care unit: A qualitative study".

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Arterburn D, Tuzzio L, Anau J, Lewis CC, Williams N, Courcoulas A, et al. (2023). "Identifying barriers to shared decision-making about bariatric surgery in two large health systems".

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Higgs, J., Patton, N., Hummell, J., Tasker, D., Croker, A., & SpringerLink (Online service). (2014). Health Practice Relationships. (Springer eBooks.) Rotterdam: SensePublishers.p.38-41

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Elwyn G, Tsulukidze M, Edwards A, Légaré F, Newcombe R (November 2013). "Using a 'talk' model of shared decision making to propose an observation-based measure: Observer OPTION 5 Item".

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Simon D, Schorr G, Wirtz M, Vodermaier A, Caspari C, Neuner B, et al. (November 2006). "Development and first validation of the shared decision-making questionnaire (SDM-Q)".

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Ferron Parayre A, Labrecque M, Rousseau M, Turcotte S, Légaré F (January 2014). "Validation of SURE, a four-item clinical checklist for detecting decisional conflict in patients".

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Höglund AT, Winblad U, Arnetz B, Arnetz JE (September 2010). "Patient participation during hospitalization for myocardial infarction: perceptions among patients and personnel".

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Härter M, Moumjid N, Cornuz J, Elwyn G, van der Weijden T (June 2017). "Shared decision making in 2017: International accomplishments in policy, research and implementation".

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policies must be designed for adequate training of professionals in integrating SDM in clinical practice, preparing them to use SDM with adequate resources and time provided.

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Légaré F, Politi MC, Drolet R, Desroches S, Stacey D, Bekker H (August 2012). "Training health professionals in shared decision-making: an international environmental scan".

188: 7008: 2107:"When doctors share visit notes with patients: a study of patient and doctor perceptions of documentation errors, safety opportunities and the patient-doctor relationship" 5039:"Improving Decision making On Location of Care with the frail Elderly and their caregivers (the DOLCE study): study protocol for a cluster randomized controlled trial" 2326:

Street RL, Gordon HS, Ward MM, Krupat E, Kravitz RL (October 2005). "Patient participation in medical consultations: why some patients are more involved than others".

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Meldrum M (2017-08-25), Worthington DL, Bodie GD (eds.), "Doctors' Interpersonal Skills Questionnaire (DISQ): (Greco, Cavanagh, Brownlea, & McGovern, 1999)",

4855:"The consultation and relational empathy (CARE) measure: development and preliminary validation and reliability of an empathy-based consultation process measure" 6774: 3224:

Kujawski E, Triantaphyllou E, Yanase J (May 2019). "Additive Multicriteria Decision Analysis Models: Misleading Aids for Life-Critical Shared Decision Making".

2056:"Patient experiences with full electronic access to health records and clinical notes through the My HealtheVet Personal Health Record Pilot: qualitative study" 6181: 4043:

Scholl I, Koelewijn-van Loon M, Sepucha K, Elwyn G, Légaré F, Härter M, et al. (2011). "Measurement of shared decision making - a review of instruments".

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Härter M, van der Weijden T, Elwyn G (2011). "Policy and practice developments in the implementation of shared decision making: an international perspective".

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In recent years, patient-centred care and shared decision-making (SDM) have become considered more important. It has been suggested that there should be more

3487:"Can patients be trained to expect shared decision making in clinical consultations? Feasibility study of a public library program to raise patient awareness" 678:

decision-making was more likely in the other types of consultation. For example, should someone have surgery or which surgery do they think is best for them?

3176:"Multiple Criteria Decision Analysis for Health Care Decision Making--Emerging Good Practices: Report 2 of the ISPOR MCDA Emerging Good Practices Task Force" 5882: 4461:

Slatore CG, Wiener RS, Golden SE, Au DH, Ganzini L (November 2016). "Longitudinal Assessment of Distress among Veterans with Incidental Pulmonary Nodules".

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In 2009, British and Australian campaigns were launched to highlight the costs of unhealthy lifestyles and the need for a culture of responsibility. The

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concerns among those who place a high value on health, leading to a tendency to let an expert, rather than themselves, make important medical decisions.

3712:"Training family physicians in shared decision-making to reduce the overuse of antibiotics in acute respiratory infections: a cluster randomized trial" 1464:

Charles C, Gafni A, Whelan T (March 1997). "Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango)".

3135:"Multiple Criteria Decision Analysis for Health Care Decision Making--An Introduction: Report 1 of the ISPOR MCDA Emerging Good Practices Task Force" 416:"A sure sign that a decision rule is faulty is when one applies it to a situation in which the answer is obvious and it produces the wrong result." 249:. Frustrated by variations in health care activity that could not be explained by population need or patient preference he described the concept of 1207:

Barry MJ, Edgman-Levitan S. Shared decision making—the pinnacle of patient-centered care. New England Journal of Medicine. 2012 Mar 1;366(9):780-1.

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took this issue seriously and since 2005, has regularly reviewed the question of patients' rights by various policies with the cooperation of the

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(29 June 2009). 3012: 3002: 2711: 2701: 2660: 2614: 2484: 2435: 2394: 2278: 2276: 2274: 2179: 2130: 2081: 2071: 2005: 1956: 1934: 1932: 1904: 1822: 1738: 1681: 1601: 1477: 1306: 16:Including patients in plans for treatment 4415:The American Journal of Gastroenterology 3992:Elwyn G, Rix A, Holt T, Jones D (2012). 3876:Israel Journal of Health Policy Research 2690:International Journal of Integrated Care 1848: 1846: 1844: 1842: 617:Measuring SDM as an indicator of quality 273:SDM relies on the basic premise of both 239:more involved in medical decision-making 5932:Politi MC, Clark MA, Ombao H, Dizon D, 5880:Graugaard PK, Finset A (January 2000). 5796:Scandinavian Journal of Caring Sciences 5421:Scandinavian Journal of Caring Sciences 4463:Annals of the American Thoracic Society 2956:10.7326/0003-4819-136-2-200201150-00010 2424:The British Journal of General Practice 2172:10.7326/0003-4819-157-7-201210020-00002 1692:10.7326/0003-4819-140-1-200401060-00012 1590:The British Journal of General Practice 834: 132: 99: 46: 39: 3946:"NHS Shared Decision Making Programme" 2509:"OPTION Instrument Sheet Translations" 6935:Health information on Knowledge (XXG) 3544:Eder M, Ivlev I, Lin JS (July 2021). 2244: 2242: 2035:. Commonwealth Fund. 16 February 2016 725:are reduced, sometimes dramatically. 261:Patient autonomy and informed consent 7: 6498:"Eisenberg Center Conference Series" 5509:Journal of General Internal Medicine 4550:The Sourcebook of Listening Research 2865:Journal of Telemedicine and Telecare 2060:Journal of Medical Internet Research 711:International Shared Decision Making 5987:Cribb A, Entwistle VA (June 2011). 4751:Quality & Safety in Health Care 1079:Kennedy Institute of Ethics Journal 716:On December 12–17, 2010, the 390:multiple-criteria decision analysis 6927:Health information on the Internet 6532:Society for Participatory Medicine 4363:Deutsches Ärzteblatt International 2340:10.1097/01.mlr.0000178172.40344.70 2206:Improving Diagnosis in Health Care 1141:The American Journal of Psychiatry 535:nderstanding the information, the 468:Shared decision-making in medicine 285:Factors that predict participation 213:traditional biomedical care system 202:Shared decision-making in medicine 14: 6113:https://doi.org/10.1111/hex.13112 4959:Journal of Interprofessional Care 4505:Journal of Investigative Medicine 2780:Journal of Interprofessional Care 2737:Journal of Health Care Chaplaincy 847:Maternal and Child Health Journal 6006:10.1111/j.1369-7625.2011.00694.x 5955:10.1111/j.1369-7625.2010.00626.x 5900:10.1097/00006842-200001000-00005 5808:10.1111/j.1471-6712.2010.00866.x 5652:Patient Education and Counseling 5619:10.1111/j.1475-6773.2005.00438.x 5570:10.1111/j.1475-6773.2006.00669.x 5521:10.1046/j.1525-1497.2002.10905.x 5433:10.1111/j.1471-6712.2009.00738.x 4896:Patient Education and Counseling 4796:Patient Education and Counseling 4676:Patient Education and Counseling 4289:Patient Education and Counseling 3761:Patient Education and Counseling 3355:Patient Education and Counseling 3004:10.1111/j.1369-7625.2008.00521.x 2607:10.1111/j.1365-2753.2010.01515.x 2532:Patient Education and Counseling 2477:10.1111/j.1369-7625.2004.00311.x 1867:10.1097/00005650-200003000-00010 1776:10.1001/jama.1988.03410040112039 1519:Patient Education and Counseling 1414:10.1097/00003086-200104000-00012 1263:Patient Education and Counseling 1185:Levenstein JH (September 1984). 978:10.1111/j.1748-3743.2010.00245.x 943:10.1111/j.1365-2702.2008.02328.x 455:With funding bodies emphasizing 227:was employed was in a report on 160: 159: 7060:Open-source healthcare software 5114:(Report). EU Health Programme; 2375:Journal of Health Communication 1001:Philosophy & Public Affairs 767:Co-production (public services) 723:Unwarranted practice variations 313:physician of a different race. 6233:10.1002/14651858.cd013124.pub2 6130:British Journal of Anaesthesia 6094:https://doi.org/10.3390/ijerph 4475:10.1513/AnnalsATS.201607-555OC 4135:10.1002/14651858.CD001431.pub4 3969:. Advancing Quality Alliance ( 3117:"IPDAS Decision Aid Checklist" 2921:10.1001/archinternmed.2007.111 1223:The Journal of Family Practice 822:Whole Health Action Management 551:Patient-provider communication 1: 5712:Archives of Internal Medicine 5088:Torrey T (25 November 2014). 2909:Archives of Internal Medicine 2792:10.1080/13561820.2018.1428186 2749:10.1080/08854726.2018.1501131 2387:10.1080/10810730.2020.1838003 1627:Journal of Bioethical Inquiry 1488:10.1016/S0277-9536(96)00221-3 1466:Social Science & Medicine 1191:South African Family Practice 792:Participative decision-making 435:theory (MAUT) and the QALYs ( 5724:10.1001/archinte.167.21.2296 5337:10.1016/j.breast.2021.06.013 5325:Breast (Edinburgh, Scotland) 4971:10.3109/13561820.2010.490502 3870:Fineberg HV (January 2012). 3512:10.1371/journal.pone.0208449 2297:10.1080/10410236.2011.552482 496:Canada, Germany and the U.S. 6877:Doctor–patient relationship 6784:Telemedicine and telehealth 6620:Doctor-patient relationship 6321:Annals of Internal Medicine 6269:BMJ (Clinical Research Ed.) 5118:. p. 6. Archived from 4011:10.1136/bmjopen-2012-001530 3085:10.1136/bmj.38926.629329.AE 2944:Annals of Internal Medicine 2160:Annals of Internal Medicine 1740:10.1001/amajethics.2020.365 1670:Annals of Internal Medicine 931:Journal of Clinical Nursing 733:Eisenberg Conference Series 437:quality-adjusted life years 67:Doctor-patient relationship 7122: 6912:Patient Activation Measure 6194:10.3310/nihrevidence_60200 4585:www.patient-als-partner.de 4558:10.1002/9781119102991.ch21 4254:10.1207/S15327027HC1301_03 4092:10.1177/0272989x9501500105 4057:10.1016/j.zefq.2011.04.012 3646:10.1016/j.zefq.2017.05.024 3615:10.1016/j.zefq.2011.04.018 3330:10.1016/j.jval.2016.10.005 3193:10.1016/j.jval.2015.12.016 3152:10.1016/j.jval.2015.12.003 1036:The Hastings Center Report 787:Patient Activation Measure 92:Social model of disability 20: 6984:Remote patient monitoring 6275:: i4852. September 2016. 6142:10.1016/j.bja.2023.03.022 5751:Annals of Family Medicine 5664:10.1016/j.pec.2010.09.025 5298:10.1007/s00063-005-1021-5 5201:10.1186/s13012-016-0480-9 5056:10.1186/s13063-015-0567-7 4908:10.1016/j.pec.2016.03.024 4808:10.1016/j.pec.2006.04.012 4689:10.1016/j.pec.2013.05.009 4623:10.1377/hlthaff.2015.1398 4375:10.3238/arztebl.2015.0672 4301:10.1016/j.pec.2018.11.003 4162:Canadian Family Physician 3773:10.1016/j.pec.2012.01.002 3562:10.1177/23814683211067522 3550:MDM Policy & Practice 3367:10.1016/j.pec.2008.07.018 2544:10.1016/j.pec.2013.08.005 2267:– via Google Books. 2123:10.1136/bmjqs-2015-004697 1639:10.1007/s11673-016-9743-z 1531:10.1016/j.pec.2005.06.010 1275:10.1016/j.pec.2011.02.004 905:10.1377/hlthaff.2012.1078 859:10.1007/s10995-014-1523-y 797:Participatory development 611:World Health Organization 6940:Online patient education 6844:Electronic health record 5607:Health Services Research 5558:Health Services Research 5150:10.1177/0025817213497149 5138:The Medico-Legal Journal 5016:10.1188/03.ONF.1022-1028 4211:10.1177/0272989x13491463 3967:"Shared Decision Making" 3681:10.1177/1363459312438563 3286:10.1177/0272989X20984134 3238:10.1177/0272989X19844740 2111:BMJ Quality & Safety 1998:10.1177/0272989X10384739 687:Involving older patients 211:In contrast to SDM, the 6434:Salzburg Global Seminar 5171:(subscription required) 4517:10.1136/jim-2016-000318 4199:Medical Decision Making 4080:Medical Decision Making 3308:Morton A (March 2017). 3273:Medical Decision Making 3226:Medical Decision Making 2877:10.1258/jtt.2009.001012 2835:10.1001/jama.2017.10289 1986:Medical Decision Making 1174:(subscription required) 802:Person-centered therapy 718:Salzburg Global Seminar 433:multi-attribute utility 340:Interprofessional model 7065:Patient opinion leader 6917:Shared decision-making 6854:Personal health record 6625:Shared decision making 6057:10.1001/jama.2020.1525 5888:Psychosomatic Medicine 5387:10.3390/ijerph18126411 5252:10.3390/ijerph18042128 5188:Implementation Science 5004:Oncology Nursing Forum 3556:(2): 238146832110675. 1958:10.1001/jama.282.6.583 1344:10.1377/hlthaff.3.2.74 762:Concordance (medicine) 757:Choosing Wisely Canada 576:shared decision-making 418: 270: 225:shared decision-making 72:Shared decision making 6897:Knowledge translation 6864:Patient participation 5472:10.1093/intqhc/mzr002 4872:10.1093/fampra/cmh621 3889:10.1186/2045-4015-1-6 2653:10.1093/geront/gny073 1727:AMA Journal of Ethics 1379:10.1377/hlthaff.3.2.6 1153:10.1176/ajp.137.5.535 807:Patient participation 747:Biopsychosocial model 457:knowledge translation 414: 303:Institute of Medicine 290:Patient participation 268: 251:unwarranted variation 7096:Practice of medicine 7070:Research participant 6700:Medical Anthropology 6645:Health professionals 4427:10.1038/ajg.2016.305 4242:Health Communication 2285:Health Communication 812:Public participation 21:For other uses, see 6791:Background concepts 6599:Medical paternalism 6369:on 29 October 2015. 5993:Health Expectations 5942:Health Expectations 5613:(6 Pt 1): 1918–30. 5286:Medizinische Klinik 4763:10.1136/qhc.12.2.93 4581:"SDM-Q-9/SDM-Q-DOC" 3728:10.1503/cmaj.120568 3503:2018PLoSO..1308449A 3056:on 5 February 2010. 2991:Health Expectations 2465:Health Expectations 1440:Dartmouth-Hitchcock 574:smart consumerism, 569:Patient empowerment 234:patient-centredness 7044:Telerehabilitation 6798:Health informatics 6462:(mar22 3): d1745. 3926:www.england.nhs.uk 3466:. Université Laval 3420:(may14 7): g3178. 2519:on 9 October 2011. 2249:Street RL (2003). 1091:10.1353/ken.0.0084 772:Disease management 623:quality indicators 271: 229:ethics in medicine 7106:Medical sociology 7083: 7082: 7019:Teleophthalmology 7009:Telemental health 6994:Tele-epidemiology 6839:De-identification 6811:Telecommunication 6750: 6749: 6653:Hidden curriculum 6568:Medical sociology 6468:10.1136/bmj.d1745 6281:10.1136/bmj.i4852 6050:(14): 1345–1346. 5843:10.1002/oby.23647 5125:on 19 March 2015. 4567:978-1-119-10299-1 4469:(11): 1983–1991. 4421:(11): 1546–1556. 3836:10.1002/chp.21197 3426:10.1136/bmj.g3178 3049:978-0-19-954627-5 2703:10.5334/ijic.2212 2641:The Gerontologist 2264:978-1-135-64766-7 2224:978-0-309-37769-0 2073:10.2196/jmir.2356 1893:Health Psychology 1815:10.1136/bmj.i6165 937:(21): 2935–2944. 668:medical guideline 659:care coordination 199: 198: 41:Medical sociology 7113: 7101:Patient advocacy 6892:Health education 6777: 6770: 6763: 6754: 6742:Patient advocacy 6674:Labelling theory 6630:Informed consent 6561: 6554: 6547: 6538: 6514: 6513: 6511: 6509: 6494: 6488: 6487: 6451: 6445: 6444: 6442: 6440: 6426: 6420: 6419: 6417: 6415: 6409:www.isdm2022.com 6401: 6395: 6394: 6392: 6391: 6377: 6371: 6370: 6359: 6353: 6352: 6333:10.7326/M16-1565 6318: 6309: 6303: 6302: 6292: 6261: 6255: 6254: 6244: 6212: 6206: 6205: 6178: 6172: 6171: 6161: 6121: 6115: 6108: 6097: 6089: 6080: 6079: 6069: 6059: 6035: 6029: 6028: 6018: 6008: 5984: 5978: 5977: 5967: 5957: 5929: 5920: 5919: 5885: 5877: 5871: 5870: 5826: 5820: 5819: 5791: 5785: 5784: 5774: 5742: 5736: 5735: 5718:(21): 2296–303. 5706: 5700: 5699: 5647: 5641: 5640: 5630: 5598: 5592: 5591: 5581: 5549: 5543: 5542: 5532: 5500: 5494: 5493: 5483: 5451: 5445: 5444: 5416: 5410: 5409: 5399: 5389: 5365: 5359: 5358: 5348: 5316: 5310: 5309: 5281: 5275: 5274: 5264: 5254: 5230: 5224: 5223: 5213: 5203: 5179: 5173: 5172: 5169: 5144:(Pt 3): 119–23. 5133: 5127: 5126: 5124: 5113: 5104: 5098: 5097: 5085: 5079: 5078: 5068: 5058: 5034: 5028: 5027: 4999: 4993: 4992: 4982: 4950: 4944: 4943: 4891: 4885: 4884: 4874: 4850: 4844: 4843: 4791: 4785: 4784: 4774: 4742: 4736: 4735: 4701: 4691: 4667: 4661: 4660: 4658: 4657: 4642: 4636: 4635: 4625: 4601: 4595: 4594: 4592: 4591: 4577: 4571: 4570: 4545: 4539: 4538: 4528: 4496: 4487: 4486: 4458: 4449: 4448: 4438: 4406: 4397: 4396: 4386: 4354: 4345: 4344: 4283: 4274: 4273: 4237: 4231: 4230: 4194: 4188: 4187: 4177: 4153: 4147: 4146: 4118: 4112: 4111: 4075: 4069: 4068: 4040: 4034: 4033: 4023: 4013: 3989: 3983: 3982: 3980: 3978: 3963: 3957: 3956: 3954: 3952: 3942: 3936: 3935: 3933: 3932: 3918: 3912: 3911: 3901: 3891: 3867: 3858: 3857: 3847: 3815: 3809: 3808: 3756: 3750: 3749: 3739: 3707: 3701: 3700: 3664: 3658: 3657: 3640:. 123–124: 1–5. 3633: 3627: 3626: 3598: 3592: 3591: 3581: 3541: 3535: 3534: 3524: 3514: 3497:(12): e0208449. 3482: 3476: 3475: 3473: 3471: 3455: 3446: 3445: 3409: 3403: 3402: 3349: 3343: 3342: 3332: 3314: 3305: 3299: 3298: 3288: 3264: 3258: 3257: 3221: 3206: 3205: 3195: 3171: 3165: 3164: 3154: 3130: 3124: 3123: 3121: 3113: 3107: 3106: 3096: 3064: 3058: 3057: 3052:. 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6175: 6123: 6122: 6118: 6109: 6100: 6090: 6083: 6037: 6036: 6032: 5986: 5985: 5981: 5931: 5930: 5923: 5879: 5878: 5874: 5828: 5827: 5823: 5793: 5792: 5788: 5763:10.1370/afm.854 5744: 5743: 5739: 5708: 5707: 5703: 5649: 5648: 5644: 5600: 5599: 5595: 5551: 5550: 5546: 5502: 5501: 5497: 5453: 5452: 5448: 5418: 5417: 5413: 5367: 5366: 5362: 5318: 5317: 5313: 5283: 5282: 5278: 5232: 5231: 5227: 5181: 5180: 5176: 5170: 5135: 5134: 5130: 5122: 5111: 5106: 5105: 5101: 5087: 5086: 5082: 5036: 5035: 5031: 5001: 5000: 4996: 4952: 4951: 4947: 4902:(10): 1717–23. 4893: 4892: 4888: 4859:Family Practice 4852: 4851: 4847: 4793: 4792: 4788: 4744: 4743: 4739: 4669: 4668: 4664: 4655: 4653: 4644: 4643: 4639: 4603: 4602: 4598: 4589: 4587: 4579: 4578: 4574: 4568: 4547: 4546: 4542: 4498: 4497: 4490: 4460: 4459: 4452: 4408: 4407: 4400: 4356: 4355: 4348: 4285: 4284: 4277: 4239: 4238: 4234: 4196: 4195: 4191: 4155: 4154: 4150: 4129:(1): CD001431. 4120: 4119: 4115: 4077: 4076: 4072: 4042: 4041: 4037: 3991: 3990: 3986: 3976: 3974: 3965: 3964: 3960: 3950: 3948: 3944: 3943: 3939: 3930: 3928: 3920: 3919: 3915: 3869: 3868: 3861: 3817: 3816: 3812: 3758: 3757: 3753: 3722:(13): E726-34. 3709: 3708: 3704: 3666: 3665: 3661: 3635: 3634: 3630: 3600: 3599: 3595: 3543: 3542: 3538: 3484: 3483: 3479: 3469: 3467: 3457: 3456: 3449: 3411: 3410: 3406: 3351: 3350: 3346: 3317:Value in Health 3312: 3307: 3306: 3302: 3266: 3265: 3261: 3223: 3222: 3209: 3180:Value in Health 3173: 3172: 3168: 3139:Value in Health 3132: 3131: 3127: 3119: 3115: 3114: 3110: 3079:(7565): 417–0. 3066: 3065: 3061: 3050: 3035: 3034: 3030: 2984: 2983: 2979: 2941: 2940: 2936: 2905: 2904: 2900: 2860: 2855: 2854: 2850: 2820: 2819: 2815: 2777: 2776: 2772: 2734: 2733: 2729: 2683: 2682: 2678: 2637: 2636: 2632: 2588: 2587: 2583: 2529: 2528: 2524: 2507: 2506: 2502: 2458: 2457: 2453: 2417: 2416: 2412: 2368: 2367: 2363: 2325: 2324: 2320: 2282: 2281: 2272: 2265: 2248: 2247: 2240: 2225: 2202: 2201: 2197: 2153: 2152: 2148: 2104: 2103: 2099: 2053: 2052: 2048: 2038: 2036: 2031: 2030: 2023: 1979: 1978: 1974: 1938: 1937: 1930: 1906:10.1.1.687.8519 1890: 1889: 1882: 1852: 1851: 1840: 1796: 1795: 1791: 1761: 1760: 1756: 1733:(5): E365-371. 1720: 1719: 1715: 1683:10.1.1.694.1979 1667: 1666: 1662: 1624: 1623: 1619: 1596:(443): 477–82. 1583: 1582: 1578: 1516: 1515: 1511: 1479:10.1.1.452.9107 1463: 1462: 1458: 1449: 1447: 1434: 1433: 1429: 1399: 1398: 1394: 1364: 1363: 1359: 1329: 1328: 1324: 1256: 1255: 1251: 1246: 1242: 1216: 1215: 1211: 1206: 1202: 1184: 1183: 1179: 1173: 1138: 1137: 1133: 1127: 1123: 1118: 1114: 1076: 1075: 1071: 1048:10.2307/3560825 1033: 1032: 1028: 998: 997: 993: 963: 962: 958: 928: 927: 920: 890: 889: 882: 844: 843: 836: 831: 826: 752:Choosing Wisely 742: 707: 698: 689: 684: 682:In primary care 654: 636: 619: 571: 562: 553: 524: 515: 498: 493: 484: 453: 410: 360: 351: 342: 333: 324: 319: 287: 263: 221: 195: 146:Social medicine 110:Talcott Parsons 26: 17: 12: 11: 5: 7119: 7117: 7109: 7108: 7103: 7098: 7088: 7087: 7081: 7080: 7078: 7077: 7072: 7067: 7062: 7056: 7054: 7050: 7049: 7047: 7046: 7041: 7036: 7034:Telepsychiatry 7031: 7026: 7021: 7016: 7011: 7006: 7001: 6996: 6991: 6989:Tele-audiology 6986: 6981: 6979:Remote therapy 6976: 6974:Remote surgery 6971: 6965: 6963: 6961:subspecialties 6956: 6955: 6953: 6952: 6950:PubMed Central 6947: 6942: 6937: 6931: 6929: 6923: 6922: 6920: 6919: 6914: 6909: 6904: 6899: 6894: 6889: 6884: 6879: 6874: 6868: 6866: 6860: 6859: 6857: 6856: 6851: 6846: 6841: 6836: 6831: 6829:Admission note 6825: 6823: 6821:Medical record 6817: 6816: 6814: 6813: 6808: 6800: 6794: 6792: 6788: 6787: 6782: 6780: 6779: 6772: 6765: 6757: 6748: 6747: 6745: 6744: 6739: 6733: 6731: 6727: 6726: 6724: 6723: 6721:Eliot Freidson 6718: 6712: 6710: 6706: 6705: 6703: 6702: 6697: 6692: 6686: 6684: 6683:Related fields 6680: 6679: 6677: 6676: 6671: 6665: 6663: 6659: 6658: 6656: 6655: 6649: 6647: 6641: 6640: 6638: 6637: 6632: 6627: 6622: 6616: 6614: 6610: 6609: 6607: 6606: 6601: 6596: 6591: 6590: 6589: 6582:Medicalization 6578: 6576: 6572: 6571: 6566: 6564: 6563: 6556: 6549: 6541: 6535: 6534: 6529: 6522: 6521:External links 6519: 6516: 6515: 6489: 6446: 6421: 6396: 6385:www.fourwav.es 6372: 6354: 6327:(2): 128–132. 6304: 6256: 6207: 6188:. 2023-10-03. 6173: 6116: 6098: 6081: 6030: 5979: 5936:(March 2011). 5921: 5872: 5837:(2): 565–573. 5821: 5786: 5737: 5701: 5642: 5593: 5564:(4): 1443–63. 5544: 5495: 5446: 5411: 5360: 5311: 5276: 5225: 5174: 5128: 5099: 5080: 5029: 4994: 4945: 4886: 4865:(6): 699–705. 4845: 4786: 4737: 4662: 4637: 4610:Health Affairs 4596: 4572: 4566: 4540: 4511:(3): 681–688. 4488: 4450: 4398: 4346: 4295:(3): 452–466. 4275: 4232: 4189: 4168:(8): e308-14. 4148: 4113: 4070: 4035: 4004:(6): e001530. 3984: 3958: 3937: 3913: 3859: 3810: 3751: 3702: 3675:(5): 531–547. 3659: 3628: 3609:(4): 229–233. 3593: 3536: 3477: 3447: 3404: 3344: 3323:(3): 512–515. 3300: 3279:(3): 261–274. 3259: 3232:(4): 437–449. 3207: 3166: 3125: 3108: 3059: 3048: 3028: 2977: 2934: 2898: 2848: 2829:(7): 657–658. 2813: 2786:(3): 284–294. 2770: 2727: 2676: 2647:(5): 822–834. 2630: 2581: 2522: 2500: 2451: 2430:(460): 892–9. 2410: 2381:(9): 681–691. 2361: 2318: 2270: 2263: 2238: 2223: 2215:10.17226/21794 2195: 2146: 2117:(4): 262–270. 2097: 2046: 2021: 1972: 1928: 1880: 1838: 1789: 1754: 1713: 1660: 1633:(4): 571–580. 1617: 1576: 1509: 1456: 1427: 1408:(385): 68–75. 1392: 1367:Health Affairs 1357: 1332:Health Affairs 1322: 1249: 1240: 1209: 1200: 1177: 1131: 1121: 1112: 1069: 1026: 991: 956: 918: 899:(2): 276–284. 893:Health Affairs 880: 853:(2): 410–418. 833: 832: 830: 827: 825: 824: 819: 814: 809: 804: 799: 794: 789: 784: 779: 774: 769: 764: 759: 754: 749: 743: 741: 738: 706: 703: 697: 694: 688: 685: 683: 680: 653: 650: 635: 632: 618: 615: 607:European Union 570: 567: 561: 558: 552: 549: 543:ncouragement. 523: 520: 514: 513:United Kingdom 511: 497: 494: 492: 489: 483: 482:Law and policy 480: 452: 451:Implementation 449: 409: 406: 383:United Kingdom 377:in Canada and 359: 356: 350: 347: 341: 338: 332: 329: 323: 320: 318: 315: 286: 283: 262: 259: 220: 217: 197: 196: 194: 193: 186: 179: 171: 168: 167: 156: 155: 154: 153: 148: 143: 135: 134: 133:Related topics 130: 129: 128: 127: 122: 117: 115:Eliot Freidson 112: 104: 103: 97: 96: 95: 94: 89: 84: 79: 74: 69: 64: 63: 62: 55:Medicalization 49: 48: 44: 43: 37: 36: 15: 13: 10: 9: 6: 4: 3: 2: 7118: 7107: 7104: 7102: 7099: 7097: 7094: 7093: 7091: 7076: 7073: 7071: 7068: 7066: 7063: 7061: 7058: 7057: 7055: 7053:Roles to play 7051: 7045: 7042: 7040: 7039:Teleradiology 7037: 7035: 7032: 7030: 7027: 7025: 7024:Telepathology 7022: 7020: 7017: 7015: 7012: 7010: 7007: 7005: 7002: 7000: 6999:Teledentistry 6997: 6995: 6992: 6990: 6987: 6985: 6982: 6980: 6977: 6975: 6972: 6970: 6967: 6966: 6964: 6962: 6959:Telemedicine 6957: 6951: 6948: 6946: 6943: 6941: 6938: 6936: 6933: 6932: 6930: 6928: 6924: 6918: 6915: 6913: 6910: 6908: 6905: 6903: 6900: 6898: 6895: 6893: 6890: 6888: 6885: 6883: 6880: 6878: 6875: 6873: 6872:Decision aids 6870: 6869: 6867: 6865: 6861: 6855: 6852: 6850: 6847: 6845: 6842: 6840: 6837: 6835: 6832: 6830: 6827: 6826: 6824: 6822: 6818: 6812: 6809: 6807: 6805: 6801: 6799: 6796: 6795: 6793: 6789: 6785: 6778: 6773: 6771: 6766: 6764: 6759: 6758: 6755: 6743: 6740: 6738: 6737:Mental health 6735: 6734: 6732: 6728: 6722: 6719: 6717: 6714: 6713: 6711: 6707: 6701: 6698: 6696: 6693: 6691: 6688: 6687: 6685: 6681: 6675: 6672: 6670: 6667: 6666: 6664: 6660: 6654: 6651: 6650: 6648: 6646: 6642: 6636: 6633: 6631: 6628: 6626: 6623: 6621: 6618: 6617: 6615: 6611: 6605: 6602: 6600: 6597: 6595: 6592: 6588: 6585: 6584: 6583: 6580: 6579: 6577: 6573: 6569: 6562: 6557: 6555: 6550: 6548: 6543: 6542: 6539: 6533: 6530: 6528: 6525: 6524: 6520: 6503: 6499: 6493: 6490: 6485: 6481: 6477: 6473: 6469: 6465: 6461: 6457: 6450: 6447: 6435: 6431: 6430:"Session 477" 6425: 6422: 6410: 6406: 6400: 6397: 6386: 6382: 6376: 6373: 6368: 6364: 6358: 6355: 6350: 6346: 6342: 6338: 6334: 6330: 6326: 6322: 6315: 6308: 6305: 6300: 6296: 6291: 6286: 6282: 6278: 6274: 6270: 6266: 6260: 6257: 6252: 6248: 6243: 6238: 6234: 6230: 6226: 6222: 6218: 6211: 6208: 6203: 6199: 6195: 6191: 6187: 6186:NIHR Evidence 6183: 6177: 6174: 6169: 6165: 6160: 6155: 6151: 6147: 6143: 6139: 6135: 6131: 6127: 6120: 6117: 6114: 6107: 6105: 6103: 6099: 6095: 6088: 6086: 6082: 6077: 6073: 6068: 6063: 6058: 6053: 6049: 6045: 6041: 6034: 6031: 6026: 6022: 6017: 6012: 6007: 6002: 5998: 5994: 5990: 5983: 5980: 5975: 5971: 5966: 5961: 5956: 5951: 5947: 5943: 5939: 5935: 5928: 5926: 5922: 5917: 5913: 5909: 5905: 5901: 5897: 5893: 5889: 5884: 5876: 5873: 5868: 5864: 5860: 5856: 5852: 5848: 5844: 5840: 5836: 5832: 5825: 5822: 5817: 5813: 5809: 5805: 5802:(3): 575–82. 5801: 5797: 5790: 5787: 5782: 5778: 5773: 5768: 5764: 5760: 5757:(3): 218–27. 5756: 5752: 5748: 5741: 5738: 5733: 5729: 5725: 5721: 5717: 5713: 5705: 5702: 5697: 5693: 5689: 5685: 5681: 5677: 5673: 5669: 5665: 5661: 5657: 5653: 5646: 5643: 5638: 5634: 5629: 5624: 5620: 5616: 5612: 5608: 5604: 5597: 5594: 5589: 5585: 5580: 5575: 5571: 5567: 5563: 5559: 5555: 5548: 5545: 5540: 5536: 5531: 5526: 5522: 5518: 5515:(4): 243–52. 5514: 5510: 5506: 5499: 5496: 5491: 5487: 5482: 5477: 5473: 5469: 5466:(3): 269–77. 5465: 5461: 5457: 5450: 5447: 5442: 5438: 5434: 5430: 5426: 5422: 5415: 5412: 5407: 5403: 5398: 5393: 5388: 5383: 5379: 5375: 5371: 5364: 5361: 5356: 5352: 5347: 5342: 5338: 5334: 5330: 5326: 5322: 5315: 5312: 5307: 5303: 5299: 5295: 5291: 5288:(in German). 5287: 5280: 5277: 5272: 5268: 5263: 5258: 5253: 5248: 5244: 5240: 5236: 5229: 5226: 5221: 5217: 5212: 5207: 5202: 5197: 5193: 5189: 5185: 5178: 5175: 5167: 5163: 5159: 5155: 5151: 5147: 5143: 5139: 5132: 5129: 5121: 5117: 5110: 5103: 5100: 5096:. About, Inc. 5095: 5091: 5084: 5081: 5076: 5072: 5067: 5062: 5057: 5052: 5048: 5044: 5040: 5033: 5030: 5025: 5021: 5017: 5013: 5010:(6): 1022–8. 5009: 5005: 4998: 4995: 4990: 4986: 4981: 4976: 4972: 4968: 4964: 4960: 4956: 4949: 4946: 4941: 4937: 4933: 4929: 4925: 4921: 4917: 4913: 4909: 4905: 4901: 4897: 4890: 4887: 4882: 4878: 4873: 4868: 4864: 4860: 4856: 4849: 4846: 4841: 4837: 4833: 4829: 4825: 4821: 4817: 4813: 4809: 4805: 4802:(3): 319–27. 4801: 4797: 4790: 4787: 4782: 4778: 4773: 4768: 4764: 4760: 4756: 4752: 4748: 4741: 4738: 4733: 4729: 4725: 4721: 4717: 4713: 4709: 4705: 4700: 4695: 4690: 4685: 4681: 4677: 4673: 4666: 4663: 4651: 4647: 4641: 4638: 4633: 4629: 4624: 4619: 4616:(4): 605–12. 4615: 4611: 4607: 4600: 4597: 4586: 4582: 4576: 4573: 4569: 4563: 4559: 4555: 4551: 4544: 4541: 4536: 4532: 4527: 4522: 4518: 4514: 4510: 4506: 4502: 4495: 4493: 4489: 4484: 4480: 4476: 4472: 4468: 4464: 4457: 4455: 4451: 4446: 4442: 4437: 4432: 4428: 4424: 4420: 4416: 4412: 4405: 4403: 4399: 4394: 4390: 4385: 4380: 4376: 4372: 4369:(40): 672–9. 4368: 4364: 4360: 4353: 4351: 4347: 4342: 4338: 4334: 4330: 4326: 4322: 4318: 4314: 4310: 4306: 4302: 4298: 4294: 4290: 4282: 4280: 4276: 4271: 4267: 4263: 4259: 4255: 4251: 4247: 4243: 4236: 4233: 4228: 4224: 4220: 4216: 4212: 4208: 4204: 4200: 4193: 4190: 4185: 4181: 4176: 4171: 4167: 4163: 4159: 4152: 4149: 4144: 4140: 4136: 4132: 4128: 4124: 4117: 4114: 4109: 4105: 4101: 4097: 4093: 4089: 4085: 4081: 4074: 4071: 4066: 4062: 4058: 4054: 4051:(4): 313–24. 4050: 4046: 4039: 4036: 4031: 4027: 4022: 4017: 4012: 4007: 4003: 3999: 3995: 3988: 3985: 3972: 3968: 3962: 3959: 3947: 3941: 3938: 3927: 3923: 3917: 3914: 3909: 3905: 3900: 3895: 3890: 3885: 3881: 3877: 3873: 3866: 3864: 3860: 3855: 3851: 3846: 3841: 3837: 3833: 3830:(4): 267–73. 3829: 3825: 3821: 3814: 3811: 3806: 3802: 3798: 3794: 3790: 3786: 3782: 3778: 3774: 3770: 3767:(2): 159–69. 3766: 3762: 3755: 3752: 3747: 3743: 3738: 3733: 3729: 3725: 3721: 3717: 3713: 3706: 3703: 3698: 3694: 3690: 3686: 3682: 3678: 3674: 3670: 3663: 3660: 3655: 3651: 3647: 3643: 3639: 3632: 3629: 3624: 3620: 3616: 3612: 3608: 3604: 3597: 3594: 3589: 3585: 3580: 3575: 3571: 3567: 3563: 3559: 3555: 3551: 3547: 3540: 3537: 3532: 3528: 3523: 3518: 3513: 3508: 3504: 3500: 3496: 3492: 3488: 3481: 3478: 3465: 3461: 3454: 3452: 3448: 3443: 3439: 3435: 3431: 3427: 3423: 3419: 3415: 3408: 3405: 3400: 3396: 3392: 3388: 3384: 3380: 3376: 3372: 3368: 3364: 3361:(3): 526–35. 3360: 3356: 3348: 3345: 3340: 3336: 3331: 3326: 3322: 3318: 3311: 3304: 3301: 3296: 3292: 3287: 3282: 3278: 3274: 3270: 3263: 3260: 3255: 3251: 3247: 3243: 3239: 3235: 3231: 3227: 3220: 3218: 3216: 3214: 3212: 3208: 3203: 3199: 3194: 3189: 3186:(2): 125–37. 3185: 3181: 3177: 3170: 3167: 3162: 3158: 3153: 3148: 3144: 3140: 3136: 3129: 3126: 3118: 3112: 3109: 3104: 3100: 3095: 3090: 3086: 3082: 3078: 3074: 3070: 3063: 3060: 3055: 3051: 3045: 3041: 3040: 3032: 3029: 3024: 3020: 3015: 3010: 3005: 3000: 2996: 2992: 2988: 2981: 2978: 2973: 2969: 2965: 2961: 2957: 2953: 2950:(2): 127–35. 2949: 2945: 2938: 2935: 2930: 2926: 2922: 2918: 2914: 2910: 2902: 2899: 2894: 2890: 2886: 2882: 2878: 2874: 2870: 2866: 2859: 2852: 2849: 2844: 2840: 2836: 2832: 2828: 2824: 2817: 2814: 2809: 2805: 2801: 2797: 2793: 2789: 2785: 2781: 2774: 2771: 2766: 2762: 2758: 2754: 2750: 2746: 2742: 2738: 2731: 2728: 2723: 2719: 2714: 2709: 2704: 2699: 2695: 2691: 2687: 2680: 2677: 2672: 2668: 2663: 2658: 2654: 2650: 2646: 2642: 2634: 2631: 2626: 2622: 2617: 2612: 2608: 2604: 2601:(4): 554–64. 2600: 2596: 2592: 2585: 2582: 2577: 2573: 2569: 2565: 2561: 2557: 2553: 2549: 2545: 2541: 2538:(2): 265–71. 2537: 2533: 2526: 2523: 2518: 2514: 2510: 2504: 2501: 2496: 2492: 2487: 2482: 2478: 2474: 2470: 2466: 2462: 2455: 2452: 2447: 2443: 2438: 2433: 2429: 2425: 2421: 2414: 2411: 2406: 2402: 2397: 2392: 2388: 2384: 2380: 2376: 2372: 2365: 2362: 2357: 2353: 2349: 2345: 2341: 2337: 2334:(10): 960–9. 2333: 2329: 2322: 2319: 2314: 2310: 2306: 2302: 2298: 2294: 2291:(5): 427–36. 2290: 2286: 2279: 2277: 2275: 2271: 2266: 2260: 2256: 2252: 2245: 2243: 2239: 2234: 2230: 2226: 2220: 2216: 2212: 2208: 2207: 2199: 2196: 2191: 2187: 2182: 2177: 2173: 2169: 2166:(7): 461–70. 2165: 2161: 2157: 2150: 2147: 2142: 2138: 2133: 2128: 2124: 2120: 2116: 2112: 2108: 2101: 2098: 2093: 2089: 2084: 2079: 2074: 2069: 2065: 2061: 2057: 2050: 2047: 2034: 2028: 2026: 2022: 2017: 2013: 2008: 2003: 1999: 1995: 1992:(3): 422–31. 1991: 1987: 1983: 1976: 1973: 1968: 1964: 1959: 1954: 1950: 1946: 1942: 1935: 1933: 1929: 1924: 1920: 1916: 1912: 1907: 1902: 1899:(3): 336–41. 1898: 1894: 1887: 1885: 1881: 1876: 1872: 1868: 1864: 1861:(3): 335–41. 1860: 1856: 1849: 1847: 1845: 1843: 1839: 1834: 1830: 1825: 1820: 1816: 1812: 1808: 1804: 1800: 1793: 1790: 1785: 1781: 1777: 1773: 1769: 1765: 1758: 1755: 1750: 1746: 1741: 1736: 1732: 1728: 1724: 1717: 1714: 1709: 1705: 1701: 1697: 1693: 1689: 1684: 1679: 1675: 1671: 1664: 1661: 1656: 1652: 1648: 1644: 1640: 1636: 1632: 1628: 1621: 1618: 1613: 1609: 1604: 1599: 1595: 1591: 1587: 1580: 1577: 1572: 1568: 1564: 1560: 1556: 1552: 1548: 1544: 1540: 1536: 1532: 1528: 1525:(3): 301–12. 1524: 1520: 1513: 1510: 1505: 1501: 1497: 1493: 1489: 1485: 1480: 1475: 1472:(5): 681–92. 1471: 1467: 1460: 1457: 1446:on 2020-12-10 1445: 1441: 1437: 1431: 1428: 1423: 1419: 1415: 1411: 1407: 1403: 1396: 1393: 1388: 1384: 1380: 1376: 1372: 1368: 1361: 1358: 1353: 1349: 1345: 1341: 1337: 1333: 1326: 1323: 1318: 1314: 1309: 1304: 1300: 1296: 1292: 1288: 1284: 1280: 1276: 1272: 1268: 1264: 1260: 1253: 1250: 1244: 1241: 1236: 1232: 1229:(4): 377–88. 1228: 1224: 1220: 1213: 1210: 1204: 1201: 1196: 1192: 1188: 1181: 1178: 1170: 1166: 1162: 1158: 1154: 1150: 1147:(5): 535–44. 1146: 1142: 1135: 1132: 1125: 1122: 1116: 1113: 1108: 1104: 1100: 1096: 1092: 1088: 1084: 1080: 1073: 1070: 1065: 1061: 1057: 1053: 1049: 1045: 1041: 1037: 1030: 1027: 1022: 1018: 1014: 1010: 1007:(4): 370–90. 1006: 1002: 995: 992: 987: 983: 979: 975: 972:(4): 274–82. 971: 967: 960: 957: 952: 948: 944: 940: 936: 932: 925: 923: 919: 914: 910: 906: 902: 898: 894: 887: 885: 881: 876: 872: 868: 864: 860: 856: 852: 848: 841: 839: 835: 828: 823: 820: 818: 815: 813: 810: 808: 805: 803: 800: 798: 795: 793: 790: 788: 785: 783: 780: 778: 775: 773: 770: 768: 765: 763: 760: 758: 755: 753: 750: 748: 745: 744: 739: 737: 734: 731: 726: 724: 719: 714: 712: 704: 702: 695: 693: 686: 681: 679: 675: 671: 669: 663: 660: 651: 649: 645: 642: 641:self-efficacy 633: 631: 628: 624: 616: 614: 612: 608: 603: 601: 597: 593: 588: 583: 579: 577: 568: 566: 559: 557: 550: 548: 544: 542: 538: 534: 530: 521: 519: 512: 510: 506: 502: 495: 490: 488: 481: 479: 475: 473: 469: 465: 462: 458: 450: 448: 444: 440: 438: 434: 429: 425: 422: 417: 413: 407: 405: 401: 397: 393: 391: 386: 384: 380: 376: 371: 370: 365: 364:decision aids 358:Decision aids 357: 355: 348: 346: 339: 337: 330: 328: 321: 317:Models of SDM 316: 314: 310: 306: 304: 298: 294: 291: 284: 282: 280: 276: 267: 260: 258: 254: 252: 248: 247:Jack Wennberg 243: 240: 235: 230: 226: 218: 216: 214: 209: 207: 203: 192: 187: 185: 180: 178: 173: 172: 170: 169: 166: 158: 157: 152: 151:Public health 149: 147: 144: 142: 139: 138: 137: 136: 131: 126: 123: 121: 118: 116: 113: 111: 108: 107: 106: 105: 102: 98: 93: 90: 88: 85: 83: 80: 78: 75: 73: 70: 68: 65: 61: 58: 57: 56: 53: 52: 51: 50: 45: 42: 38: 34: 30: 29: 24: 19: 7029:Telepharmacy 6803: 6709:Sociologists 6613:Medical care 6594:Iatrogenesis 6587:of sexuality 6508:19 September 6506:. 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Retrieved 4652:. 2019-09-16 4649: 4640: 4613: 4609: 4599: 4588:. Retrieved 4584: 4575: 4549: 4543: 4508: 4504: 4466: 4462: 4418: 4414: 4366: 4362: 4292: 4288: 4248:(1): 19–31. 4245: 4241: 4235: 4205:(1): 54–62. 4202: 4198: 4192: 4165: 4161: 4151: 4126: 4116: 4086:(1): 25–30. 4083: 4079: 4073: 4048: 4044: 4038: 4001: 3997: 3987: 3975:. Retrieved 3961: 3949:. Retrieved 3940: 3929:. Retrieved 3925: 3916: 3879: 3875: 3827: 3823: 3813: 3764: 3760: 3754: 3719: 3715: 3705: 3672: 3668: 3662: 3637: 3631: 3606: 3602: 3596: 3553: 3549: 3539: 3494: 3490: 3480: 3468:. 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