Title
Shared decision making in endocrinology: present and future directions
Date Issued
01 August 2016
Access level
metadata only access
Resource Type
review
Author(s)
Rodriguez-Gutierrez R.
Gionfriddo M.R.
Ospina N.S.
Maraka S.
Tamhane S.
Brito J.P.
Clinica Mayo, Rochester
Publisher(s)
Lancet Publishing Group
Abstract
In medicine and endocrinology, there are few clinical circumstances in which clinicians can accurately predict what is best for their patients. As a result, patients and clinicians frequently have to make decisions about which there is uncertainty. Uncertainty results from limitations in the research evidence, unclear patient preferences, or an inability to predict how treatments will fit into patients' daily lives. The work that patients and clinicians do together to address the patient's situation and engage in a deliberative dialogue about reasonable treatment options is often called shared decision making. Decision aids are evidence-based tools that facilitate this process. Shared decision making is a patient-centred approach in which clinicians share information about the benefits, harms, and burden of different reasonable diagnostic and treatment options, and patients explain what matters to them in view of their particular values, preferences, and personal context. Beyond the ethical argument in support of this approach, decision aids have been shown to improve patients' knowledge about the available options, accuracy of risk estimates, and decisional comfort. Decision aids also promote patient participation in the decision-making process. Despite accumulating evidence from clinical trials, policy support, and expert recommendations in endocrinology practice guidelines, shared decision making is still not routinely implemented in endocrine practice. Additional work is needed to enrich the number of available tools and to implement them in practice workflows. Also, although the evidence from randomised controlled trials favours the use of this shared decision making in other settings, populations, and illnesses, the effect of this approach has been studied in a few endocrine disorders. Future pragmatic trials are needed to explore the effect and feasibility of shared decision making implementation into routine endocrinology and primary care practice. With the available evidence, however, endocrinologists can now start to practice shared decision making, partner with their patients, and use their expertise to formulate treatment plans that reflect patient preferences and are more likely to fit into the context of patients' lives. In this Personal View, we describe shared decision making, the evidence behind the approach, and why and how both endocrinologists and their patients could benefit from this approach.
Start page
706
End page
716
Volume
4
Issue
8
Language
English
OCDE Knowledge area
Endocrinología, Metabolismo (incluyendo diabetes, hormonas)
Scopus EID
2-s2.0-84966657005
PubMed ID
Source
The Lancet Diabetes and Endocrinology
ISSN of the container
2213-8587
Sponsor(s)
This work was made possible by a CTSA grant (number TL1 TR000137, to MRG) from the US National Center for Advancing Translational Science, part of the National Institutes of Health (NIH). The contents of this report are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. We thank the Patient Research Advisory Group, a group of patients with diabetes from the community that has met with investigators of the Knowledge and Evaluation Research Unit at the Mayo Clinic (Rochester, MN, USA) for the past decade to help direct their work on what matters to patients.
Sources of information: Directorio de Producción Científica Scopus