Shared Decision-Making in Health Care

When the first edition of this book came out in 2001, it examined the emerging themes of patient choice and clinical decision-making, and looked at how these might develop in the future. Since then, these issues have become even more topical. Evidence-based medicine is deeply ingrained in the practice of modern medicine, while patient choice is increasingly high on the political agenda. But can the two trends co-exist? "Shared Decision Making" has developed in response to the sometimes uneasy relationship between a patient's right to have input into their treatment options, and a clinician's responsibility to provide the best evidence-based health care. Imagine a patient with osteoarthritis in her knee. She and her doctor are considering whether she would benefit from surgery to replace her knee joint. This sort of decision is typical of many in health care where there is more than one reasonable alternative available to the patient and her doctor. These alternatives include surgery, physiotherapy, medication, complementary remedies, and more. What is right for one patient may be different from what is right for another. Clinical information (such as results of x-rays or even patient-reported symptom score) though necessary, is not sufficient to determine the best treatment.

Adrian Edwards is Professor of General Practice at the Department of Primary Care and Public Health at Cardiff University. He is also a part-time general practitioner in Cwmbran, Gwent, South Wales seeing about 80 patients per week, and holds a visiting chair at the University of South Denmark in Odense. His two main research interests are in risk communication as part of shared decision-making, and in quality improvement in primary care. Among the former, research work has included the development and evaluation of training for doctors in risk communication approaches, and simple decision aids for use in consultations. More recently this has focused on development of interactive decision aids that might be used outside consultations. Other more 'fundamental' work is looking at the notion and application of Health Literacy initiatives that may underpin patient involvement in shared decision-making. Glyn Elwyn is a primary care clinician who has research interests in shared decision-making, decision support technologies, risk communication and the integration of health informatics into clinical practice. He has published 150 peer-reviewed articles. He was appointed as one of the inter-school Link Chairs at Cardiff University in May 2005, and leads the Clinical Epidemiology Interdisciplinary Research Group at the School of Medicine (2007). In collaboration with Professor Adrian Edwards, he convenes a research group on decision-making and the development of web-based interactive decision support materials (see www.prosdex.com, www.amniodex.com, www.bresdex.com). He is involved in the supervision of 10 PhD students. He holds a visiting chair position at 'IQ', the Scientific Institute for Quality of Healthcare, Radboud University & Medical Centre, Nijmegen, The Netherlands.He co-leads the International Patient Decision Aids Standards Collaboration with Professor Annette O'Connor, Ottawa, Canada.