Shared decision making is an ethical imperative, but implementation challenges persist: A rejoinder to 'Concepts of health, ethics, and communication in shared decision making' by Lauris Kaldjian

摘要

The physician is the medical expert, but the patient is an expert on his or her own sense of well-being. Shared decision making is a clinical approach that aims to bridge the gap between the two parties by providing the physician with the tools to enable the patient to communicate their values or goals of care. Kaldjian (2017) indicates that patient preferences are embedded within their 'concept of health framework; each individual has a unique definition offlourishment in the context of healthcare. This 'concept of health' can serve as the foundation for the interaction and provide the physician with a window into the factors (physical, psychosocial, cultural) that make up a patient's perspective. From Kaldjian's point of view, if a physician can tap into the patient's 'concept of health, he or she can better understand the patient's decision making -particularly when there is disagreement regarding the best treatment option. In this circumstance, a physician can only communicate the medical and ethical reasoning behind their recommended therapy, while respecting the patient's autonomy. Shared decision making enables this two-way communication, so even when disagreement arises, both parties understand each other's reasoning.