Helping People Share Decision Making

Over the past decade health care systems around the world have placed increasing importance on the relationship between patient choice and clinical decision-making. In the years since the publication of the second edition of Shared Decision Making in Health Care, there have been significant new developments in the field, most notably in the US where 'Obamacare' puts shared decision making (SDM) at the centre of the 2009 Affordable Care Act. This new edition explores shared decision making by examining, from practical and theoretical perspectives, what should comprise an effective decision-making process. It also looks at the benefits and potential difficulties that arise when patients and clinicians share health care decisions. Written by leading experts from around the world and utilizing high quality evidence, the book provides an up-to-date reference with real-word context to the topics discussed, and in-depth coverage of the practicalities of implementing and teaching SDM. The breadth of information in Shared Decision Making in Health Care makes it an essential resource for policy-makers and health care workers. As health care systems adapt to increasingly collaborative patient-clinician care frameworks, this will also prove a useful guide to SDM for clinicians of all disciplines.

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An evidence-based analysis of the opportunities and challenges of moving towards more person-centred health systems.

This book examines the regulation and practice of medical decision-making where the context is that of a multiple pregnancy and where the question is whether or not to carry out a fetal reduction procedure. It concerns three main lines of inquiry: first, the nature of fetal reduction and the legal ground(s) for termination typically relied upon; secondly, the extent to which legal, ethical, and professional norms guide or constrain this particular kind of decision-making; and, thirdly, the adequacy of these norms. The book uses empirical sources to develop its analysis, contributing new insight and the kind of evidence necessary to shape regulation, clinical practice, and future research. The key findings show that fetal abnormality is often given as the justifying ground; that the legal, ethical, and professional norms offer little explicit guidance for fetal reduction: and on the general question of termination, ethical norms suffer from a high level of contestation, the key norms in the UK abortion legislation are unclear and disconnected from practice, and professional norms are only marginally more adequate. Given the indeterminacy of these norms, it is no surprise that the evidence indicates that doctors are only weakly guided by them in making their decisions. Various recommendations are advanced in this book, including the need for a situational emphasis on shared decision-making and patient-centred care.

This report clarifies what is meant by 'shared decision-making' and identifies the skills and resources needed to implement it. It outlines the actions needed to make this vision a reality. It also suggests that tools that help patients make decisions are just as important as guidelines for clinicians.

Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.