A study of the decision-making processes for the medical care of chronic hemodialysis patients

Abstract

Abstract--Shared decision-making is increasingly advocated as an ideal model of treatment decision- making in the medical encounter. To date, the concept has been rather poorly and loosely defined. This paper attempts to provide greater conceptual clarity about shared treatment decision-making, identify some key characteristics of this model, and d scuss measurement issues. The particular decision-making context that we focus on is potentially life threatening illnesses, where there are important decisions to be made at key points in the disease process, and several treatment options exist with different possible outcomes and substantial uncertainty. We suggest as key characteristics of shared decision-making (1) that at least two participants--physician and patient be involved; (2) that both parties share infor- mation; (3) that both parties take steps to build a consensus about the preferred treatment; and (4) that an agreement is reached on the treatment to implement. Some challenges to measuring shared decision- making are discussed as well as potential benefits of a shared decision-making model for both phys- icians and patients.