|
Sign In to gain access to subscriptions and/or personal tools.
|
A New Model of Medical Decisions: Exploring the Limits of Shared Decision Making
Simon N. Whitney, MD, JD
Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, switney{at}bcm.tmc.edu
This article proposes a model of medical decisions based on 2 fundamental characteristics of each decision—importance and certainty. Importance reflects a combination of objective and subjective factors; certainty is present if 1 intervention is superior and absent if 2 or more interventions are approximately equal. The proposed model uses these characteristics to predict who will have decisional priority for any given decision and shows how one class of decisions lends itself particularly well to shared decision making. Three other types of decisions are less well suited to a collaborative decision: 1) For major choices that have low certainty, patients should be encouraged to be the primary decision makers, with physician assistance as needed. 2) Most minor decisions that have high certainty are expected to be made by physicians. 3) Major decisions that have high certainty are likely to cause serious conflict when patients and physicians disagree.
Key Words: decision making • medical ethics • informed consent • theoretical models • patient participation • physician-patient relations
Medical Decision Making, Vol. 23, No. 4,
275-280 (2003)
DOI: 10.1177/0272989X03256006
 CiteULike  Complore  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter What's this?
This article has been cited by other articles:
|
|
|
|
 
P. K. J. Han, W. M. P. Klein, T. C. Lehman, H. Massett, S. C. Lee, and A. N. Freedman
Laypersons' Responses to the Communication of Uncertainty Regarding Cancer Risk Estimates
Med Decis Making,
May 1, 2009;
29(3):
391 - 403.
[Abstract]
[PDF]
|
|
|
|
|
|
|
S. N. Whitney, M. Holmes-Rovner, H. Brody, C. Schneider, L. B. McCullough, R. J. Volk, and A. L. McGuire
Beyond Shared Decision Making: An Expanded Typology of Medical Decisions
Med Decis Making,
September 1, 2008;
28(5):
699 - 705.
[Abstract]
[PDF]
|
|
|
|
|
|
|
P. K.J. Han, S. C. Kobrin, W. M.P. Klein, W. W. Davis, M. Stefanek, and S. H. Taplin
Perceived Ambiguity about Screening Mammography Recommendations: Association with Future Mammography Uptake and Perceptions
Cancer Epidemiol. Biomarkers Prev.,
March 1, 2007;
16(3):
458 - 466.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Helfand and L. Saxton
Medical Decision Making and Electronic Publishing
Med Decis Making,
March 1, 2007;
27(2):
98 - 100.
[PDF]
|
|
|
|
|
|
|
S. N. Whitney, A. M. Ethier, E. Fruge, S. Berg, L. B. McCullough, and M. Hockenberry
Decision Making in Pediatric Oncology: Who Should Take the Lead? The Decisional Priority in Pediatric Oncology Model
J. Clin. Oncol.,
January 1, 2006;
24(1):
160 - 165.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. J. Treharne, A. C. Lyons, E. D. Hale, K. M. J. Douglas, and G. D. Kitas
'Compliance' is futile but is 'concordance' between rheumatology patients and health professionals attainable?
Rheumatology,
January 1, 2006;
45(1):
1 - 5.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. A. McNutt
Shared Medical Decision Making: Problems, Process, Progress
JAMA,
November 24, 2004;
292(20):
2516 - 2518.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. M. Epstein, B. S. Alper, and T. E. Quill
Communicating Evidence for Participatory Decision Making
JAMA,
May 19, 2004;
291(19):
2359 - 2366.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. N. Whitney, A. L. McGuire, and L. B. McCullough
A Typology of Shared Decision Making, Informed Consent, and Simple Consent
Ann Intern Med,
January 6, 2004;
140(1):
54 - 59.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
