MAYO CLINIC PROCEEDINGS
Shared Decision Making: An Alternative View To the Editor: In a recent conference on shared decision making (SDM) in health care chaired by author and patient advocate Angela Coulter that was held at the University of Oxford, United Kingdom,1 a lively debate ensued that focused on the best ways to overcome difficulties, train physicians, and assist patients in achieving this desirable goal. It is ironic, perhaps, that in these patient-centered discussions, the voice of the patient typically remains unheard, and indeed, as far as SDM is concerned, all patients are often regarded as one, whereas heterogeneity among cultures and within a culture is inevitable. However, a substantial minority of patients prefer not to be told too much about their illness,2 and patients’ own preferences for joining in decision making have been found to be weak, showing even more decline when they were asked to consider increasingly severe illnesses.3 Physicians were no different in that respect. The stress and anxiety of severe disease diagnosis or hospitalization may further affect
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patients’ judgment, cognitive function, and wish or ability to participate as competent partners in SDM. The past editor of the New England Journal of Medicine, Franz Ingelfinger, related most eloquently in a 1980 Special Article that when diagnosed with cancer and flooded with options, he was in agony, craving for an authoritarian decision.4 Many factors affect patients’ willingness to participate in decisions,5 and the first shared decision to be considered had better be whether and to what extent the patient desires it. Ami Schattner, MD Ethox Centre Department of Public Health University of Oxford Oxford, UK
Hebrew University Hadassah Medical School Jerusalem, Israel 1. The GTC Management in Medicine Programme. http://mim.gtc.ox.ac.uk/index.php/speaker-events/31. html. Accessed December 16, 2013. 2. Schattner A, Tal M. Truth telling and patient autonomy: the patient’s point of view. Am J Med. 2002; 113(1):66-69. 3. Ende J, Kazis L, Ash A, Moskowitz MA. Measuring patients’ desire for autonomy: decision making
and information-seeking preferences among medical patients. J Gen Intern Med. 1989;4(1):23-30. 4. Ingelfinger FJ. Arrogance. N Engl J Med. 1980; 303(26):1507-1511. 5. Longtin Y, Sax H, Leape LL, Sheridan SE, Donaldson L, Pittet D. Patient participation: current knowledge and applicability to patient safety. Mayo Clin Proc. 2010; 85(1):53-62. http://dx.doi.org/10.1016/j.mayocp.2013.12.005
CORRECTION In the article “The Mayo Clinic Biobank: A Building Block for Individualized Medicine,” published in the September 2013 issue of Mayo Clinic Proceedings (2013;88(9):952-962), the grant information was incomplete. The correct grant information is as follows: This publication was supported by Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS) and Grant U01 HG004599 and U01 HG006379 from the National Human Genome Research Institute (NHGRI). http://dx.doi.org/10.1016/j.mayocp.2013.12.007
Mayo Clin Proc. n February 2014;89(2):274-276 www.mayoclinicproceedings.org
Shared Decision Making: An Alternative View To the Editor: In a recent conference on shared decision making (SDM) in health care chaired by author and patient advocate Angela Coulter that was held at the University of Oxford, United Kingdom,1 a lively debate ensued that focused on the best ways to overcome difficulties, train physicians, and assist patients in achieving this desirable goal. It is ironic, perhaps, that in these patient-centered discussions, the voice of the patient typically remains unheard, and indeed, as far as SDM is concerned, all patients are often regarded as one, whereas heterogeneity among cultures and within a culture is inevitable. However, a substantial minority of patients prefer not to be told too much about their illness,2 and patients’ own preferences for joining in decision making have been found to be weak, showing even more decline when they were asked to consider increasingly severe illnesses.3 Physicians were no different in that respect. The stress and anxiety of severe disease diagnosis or hospitalization may further affect
276
patients’ judgment, cognitive function, and wish or ability to participate as competent partners in SDM. The past editor of the New England Journal of Medicine, Franz Ingelfinger, related most eloquently in a 1980 Special Article that when diagnosed with cancer and flooded with options, he was in agony, craving for an authoritarian decision.4 Many factors affect patients’ willingness to participate in decisions,5 and the first shared decision to be considered had better be whether and to what extent the patient desires it. Ami Schattner, MD Ethox Centre Department of Public Health University of Oxford Oxford, UK
Hebrew University Hadassah Medical School Jerusalem, Israel 1. The GTC Management in Medicine Programme. http://mim.gtc.ox.ac.uk/index.php/speaker-events/31. html. Accessed December 16, 2013. 2. Schattner A, Tal M. Truth telling and patient autonomy: the patient’s point of view. Am J Med. 2002; 113(1):66-69. 3. Ende J, Kazis L, Ash A, Moskowitz MA. Measuring patients’ desire for autonomy: decision making
and information-seeking preferences among medical patients. J Gen Intern Med. 1989;4(1):23-30. 4. Ingelfinger FJ. Arrogance. N Engl J Med. 1980; 303(26):1507-1511. 5. Longtin Y, Sax H, Leape LL, Sheridan SE, Donaldson L, Pittet D. Patient participation: current knowledge and applicability to patient safety. Mayo Clin Proc. 2010; 85(1):53-62. http://dx.doi.org/10.1016/j.mayocp.2013.12.005
CORRECTION In the article “The Mayo Clinic Biobank: A Building Block for Individualized Medicine,” published in the September 2013 issue of Mayo Clinic Proceedings (2013;88(9):952-962), the grant information was incomplete. The correct grant information is as follows: This publication was supported by Grant Number UL1 TR000135 from the National Center for Advancing Translational Sciences (NCATS) and Grant U01 HG004599 and U01 HG006379 from the National Human Genome Research Institute (NHGRI). http://dx.doi.org/10.1016/j.mayocp.2013.12.007
Mayo Clin Proc. n February 2014;89(2):274-276 www.mayoclinicproceedings.org
