IDEAS home Printed from https://ideas.repec.org/a/sae/medema/v28y2008i5p699-705.html
   My bibliography  Save this article

Beyond Shared Decision Making: An Expanded Typology of Medical Decisions

Author

Listed:
  • Simon N. Whitney

    (Department of Family and Community Medicine, Baylor College of Medicine, Houston Center for Education and Research on Therapeutics, Houston, TX, swhitney@bcm.edu)

  • Margaret Holmes-Rovner

    (Health Services Research, Michigan State University, Center for Ethics & Humanities in the Life Sciences, E. Lansing)

  • Howard Brody

    (Family Medicine, Institute for the Medical Humanities, University of Texas Medical Branch, Galveston)

  • Carl Schneider

    (University of Michigan Law School, Ann Arbor)

  • Laurence B. McCullough

    (Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX)

  • Robert J. Volk

    (Department of Family and Community Medicine, Baylor College of Medicine, Houston Center for Education and Research on Therapeutics, Houston, TX)

  • Amy L. McGuire

    (Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX)

Abstract

The most popular current models of medical decision making, identified by names such as shared decision making, informed decision making, and evidence-based patient choice, portray an empowered patient actively involved in his or her medical choices and generally assume that patient and physician reach agreement. These models are limited to a specific type of decision (in which there is more than one choice) and a specific process (in which agreement is reached). The authors extend the model of medical decision making beyond shared decisions in 2 dimensions. First, the authors incorporate a class of medical decisions in which there is only one medically reasonable treatment option, such as the removal of a primary melanoma. Patient preferences are irrelevant to whether or not the melanoma should be removed, so there is no treatment choice in which the patient can share. When there is only one realistic treatment option, the clinician's job is not to offer alternatives but to explain why there is only one viable choice and move the decision-making process forward. The physician does not thereby abridge the patient's autonomy; rather, the disease process itself constrains both patient and physician. Second, the authors include decisions in which patient and physician do not reach agreement. Sometimes the patient insists on a particular treatment and the physician reluctantly yields, sometimes it is the other way around, but disagreement is commonplace in clinical medicine and its presence deserves inclusion in the way we think about medical decisions. Conflict resolution requires acknowledging the potential for conflict.

Suggested Citation

  • Simon N. Whitney & Margaret Holmes-Rovner & Howard Brody & Carl Schneider & Laurence B. McCullough & Robert J. Volk & Amy L. McGuire, 2008. "Beyond Shared Decision Making: An Expanded Typology of Medical Decisions," Medical Decision Making, , vol. 28(5), pages 699-705, September.
  • Handle: RePEc:sae:medema:v:28:y:2008:i:5:p:699-705
    DOI: 10.1177/0272989X08318465
    as

    Download full text from publisher

    File URL: https://journals.sagepub.com/doi/10.1177/0272989X08318465
    Download Restriction: no

    File URL: https://libkey.io/10.1177/0272989X08318465?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Charles, Cathy & Gafni, Amiram & Whelan, Tim, 1997. "Shared decision-making in the medical encounter: What does it mean? (or it takes at least two to tango)," Social Science & Medicine, Elsevier, vol. 44(5), pages 681-692, March.
    2. Charles, Cathy & Gafni, Amiram & Whelan, Tim, 1999. "Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model," Social Science & Medicine, Elsevier, vol. 49(5), pages 651-661, September.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Alarape, A. A. & Adegboye M. O. & Ogunniran O. O & Omoba, F. A, 2021. "Health Information Resources and Clinical Core Skills as Predictors of Medical Doctors Clinical Decision Making in Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria," International Journal of Research and Innovation in Social Science, International Journal of Research and Innovation in Social Science (IJRISS), vol. 5(6), pages 175-184, June.
    2. Mendick, Nicola & Young, Bridget & Holcombe, Christopher & Salmon, Peter, 2010. "The ethics of responsibility and ownership in decision-making about treatment for breast cancer: Triangulation of consultation with patient and surgeon perspectives," Social Science & Medicine, Elsevier, vol. 70(12), pages 1904-1911, June.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Karnieli-Miller, Orit & Eisikovits, Zvi, 2009. "Physician as partner or salesman? Shared decision-making in real-time encounters," Social Science & Medicine, Elsevier, vol. 69(1), pages 1-8, July.
    2. Paul C. Schroy III & Karen Emmons & Ellen Peters & Julie T. Glick & Patricia A. Robinson & Maria A. Lydotes & Shamini Mylvanaman & Stephen Evans & Christine Chaisson & Michael Pignone & Marianne Prout, 2011. "The Impact of a Novel Computer-Based Decision Aid on Shared Decision Making for Colorectal Cancer Screening," Medical Decision Making, , vol. 31(1), pages 93-107, January.
    3. Coast, Joanna, 2018. "A history that goes hand in hand: Reflections on the development of health economics and the role played by Social Science & Medicine, 1967–2017," Social Science & Medicine, Elsevier, vol. 196(C), pages 227-232.
    4. Tate, Alexandra, 2020. "Invoking death: How oncologists discuss a deadly outcome," Social Science & Medicine, Elsevier, vol. 246(C).
    5. Wirtz, Veronika & Cribb, Alan & Barber, Nick, 2006. "Patient-doctor decision-making about treatment within the consultation--A critical analysis of models," Social Science & Medicine, Elsevier, vol. 62(1), pages 116-124, January.
    6. Shosh Shahrabani & Amiram Gafni & Uri Ben-Zion, 2008. "Low Flu Shot Rates Puzzle—Some Plausible Behavioral Explanations," The American Economist, Sage Publications, vol. 52(1), pages 66-72, March.
    7. Peek, Monica E. & Odoms-Young, Angela & Quinn, Michael T. & Gorawara-Bhat, Rita & Wilson, Shannon C. & Chin, Marshall H., 2010. "Race and shared decision-making: Perspectives of African-Americans with diabetes," Social Science & Medicine, Elsevier, vol. 71(1), pages 1-9, July.
    8. May, Carl, 2013. "Agency and implementation: Understanding the embedding of healthcare innovations in practice," Social Science & Medicine, Elsevier, vol. 78(C), pages 26-33.
    9. Entwistle, Vikki & Williams, Brian & Skea, Zoe & MacLennan, Graeme & Bhattacharya, Siladitya, 2006. "Which surgical decisions should patients participate in and how? Reflections on women's recollections of discussions about variants of hysterectomy," Social Science & Medicine, Elsevier, vol. 62(2), pages 499-509, January.
    10. Glory Apantaku & Magda Aguiar & K. Julia Kaal & Patrick J. McDonald & Mary B. Connolly & Viorica Hrincu & Judy Illes & Mark Harrison, 2022. "Understanding Attributes that Influence Physician and Caregiver Decisions About Neurotechnology for Pediatric Drug-Resistant Epilepsy: A Formative Qualitative Study to Support the Development of a Dis," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 15(2), pages 219-232, March.
    11. Mendick, Nicola & Young, Bridget & Holcombe, Christopher & Salmon, Peter, 2010. "The ethics of responsibility and ownership in decision-making about treatment for breast cancer: Triangulation of consultation with patient and surgeon perspectives," Social Science & Medicine, Elsevier, vol. 70(12), pages 1904-1911, June.
    12. Hardman, Doug & Geraghty, Adam W.A. & Lown, Mark & Bishop, Felicity L., 2020. "Subjunctive medicine: Enacting efficacy in general practice," Social Science & Medicine, Elsevier, vol. 245(C).
    13. France Légaré & Stéphane Turcotte & Dawn Stacey & Stéphane Ratté & Jennifer Kryworuchko & Ian Graham, 2012. "Patients’ Perceptions of Sharing in Decisions," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 5(1), pages 1-19, March.
    14. Bugge, Carol & Entwistle, Vikki A. & Watt, Ian S., 2006. "The significance for decision-making of information that is not exchanged by patients and health professionals during consultations," Social Science & Medicine, Elsevier, vol. 63(8), pages 2065-2078, October.
    15. Flora Kuehne & Linda Sanftenberg & Tobias Dreischulte & Jochen Gensichen, 2020. "Shared Decision Making Enhances Pneumococcal Vaccination Rates in Adult Patients in Outpatient Care," IJERPH, MDPI, vol. 17(23), pages 1-15, December.
    16. Amber E. Barnato & Hilary A. Llewellyn-Thomas & Ellen M. Peters & Laura Siminoff & E. Dale Collins & Michael J. Barry, 2007. "Communication and Decision Making in Cancer Care: Setting Research Priorities for Decision Support/Patients' Decision Aids," Medical Decision Making, , vol. 27(5), pages 626-634, September.
    17. Specker Sullivan, Laura, 2017. "Dynamic axes of informed consent in Japan," Social Science & Medicine, Elsevier, vol. 174(C), pages 159-168.
    18. Christoph Engel & Werner Gueth, 2018. "Modeling a satisficing judge," Rationality and Society, , vol. 30(2), pages 220-246, May.
    19. Michael Saheb Kashaf & Elizabeth McGill, 2015. "Does Shared Decision Making in Cancer Treatment Improve Quality of Life? A Systematic Literature Review," Medical Decision Making, , vol. 35(8), pages 1037-1048, November.
    20. Thomas, Elizabeth C. & Bass, Sarah Bauerle & Siminoff, Laura A., 2021. "Beyond rationality: Expanding the practice of shared decision making in modern medicine," Social Science & Medicine, Elsevier, vol. 277(C).

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:sae:medema:v:28:y:2008:i:5:p:699-705. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: SAGE Publications (email available below). General contact details of provider: .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.