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Patient Educ Couns. 2016 Sep;99(9):1505-10. doi: 10.1016/j.pec.2016.07.014. Epub 2016 Jul 7.

Shared decision-making as an existential journey: Aiming for restored autonomous capacity.

Author information

1
Institute of Clinical Medicine, University of Oslo, Oslo, Norway; HØKH Research Centre, Akershus University Hospital, Lørenskog, Norway. Electronic address: pal.gulbrandsen@medisin.uio.no.
2
American Institutes for Research, 10 S Riverside Plaza, Suite 600, Chicago, IL, USA.
3
Johns Hopkins University School of Medicine, Baltimore, MD, USA.
4
Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME, USA.
5
Department of Internal Medicine, Nordland Hospital, Bodø, Norway.
6
The Preference Laboratory, The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA.

Abstract

OBJECTIVE:

We describe the different ways in which illness represents an existential problem, and its implications for shared decision-making.

METHODS:

We explore core concepts of shared decision-making in medical encounters (uncertainty, vulnerability, dependency, autonomy, power, trust, responsibility) to interpret and explain existing results and propose a broader understanding of shared-decision making for future studies.

RESULTS:

Existential aspects of being are physical, social, psychological, and spiritual. Uncertainty and vulnerability caused by illness expose these aspects and may lead to dependency on the provider, which underscores that autonomy is not just an individual status, but also a varying capacity, relational of nature. In shared decision-making, power and trust are important factors that may increase as well as decrease the patient's dependency, particularly as information overload may increase uncertainty.

CONCLUSION:

The fundamental uncertainty, state of vulnerability, and lack of power of the ill patient, imbue shared decision-making with a deeper existential significance and call for greater attention to the emotional and relational dimensions of care. Hence, we propose that the aim of shared decision-making should be restoration of the patient's autonomous capacity.

PRACTICE IMPLICATIONS:

In doing shared decision-making, care is needed to encompass existential aspects; informing and exploring preferences is not enough.

KEYWORDS:

Autonomy; Decisional agency; Dependency; Existential process; Physician roles; Power; Responsibility; Shared decision-making; Trust; Uncertainty; Vulnerability

PMID:
27460801
DOI:
10.1016/j.pec.2016.07.014
[Indexed for MEDLINE]

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