Potential Unintended Consequences Of Recent Shared Decision Making Policy Initiatives

Jennifer Blumenthal-Barby; Douglas J Opel; Neal W Dickert; Daniel B Kramer; Brownsyne Tucker Edmonds; Keren Ladin; Monica E Peek; Jeff Peppercorn; Jon Tilburt

doi:10.1377/hlthaff.2019.00243

Potential Unintended Consequences Of Recent Shared Decision Making Policy Initiatives

Health Aff (Millwood). 2019 Nov;38(11):1876-1881. doi: 10.1377/hlthaff.2019.00243.

Authors

Jennifer Blumenthal-Barby¹, Douglas J Opel², Neal W Dickert³, Daniel B Kramer⁴, Brownsyne Tucker Edmonds⁵, Keren Ladin⁶, Monica E Peek⁷, Jeff Peppercorn⁸, Jon Tilburt⁹

Affiliations

¹ Jennifer Blumenthal-Barby ( jsswinde@bcm. edu ) is the Cullen Associate Professor and associate director of the Center for Medical Ethics and Health Policy, Baylor College of Medicine, in Houston, Texas.
² Douglas J. Opel is an associate professor of pediatrics at the University of Washington School of Medicine and director of clinical ethics at the Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, in Washington.
³ Neal W. Dickert is an associate professor of cardiology and epidemiology at Emory University, in Atlanta, Georgia.
⁴ Daniel B. Kramer is an assistant professor at Harvard Medical School and faculty at the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, both in Boston, Massachusetts.
⁵ Brownsyne Tucker Edmonds is an associate professor of obstetrics and gynecology and assistant dean for diversity affairs at the Indiana University School of Medicine, in Indianapolis.
⁶ Keren Ladin is an assistant professor of occupational therapy and community health at Tufts University, in Medford, Massachusetts.
⁷ Monica E. Peek is an associate professor of medicine at the University of Chicago Medical Center, in Illinois.
⁸ Jeff Peppercorn is an associate professor in and director of the Cancer Survivorship Program, Cancer Center, Massachusetts General Hospital, in Boston.
⁹ Jon Tilburt is a professor of internal medicine and biomedical ethics at Mayo Clinic in Rochester, Minnesota.

Abstract

Shared decision making (SDM)-when clinicians and patients make medical decisions together-is moving swiftly from an ethical ideal toward widespread clinical implementation affecting millions of patients through recent policy initiatives. We argue that policy initiatives to promote SDM implementation in clinical practice carry the risk of several unintended negative consequences if limitations in defining and measuring SDM are not addressed. We urge policy makers to include prespecified definitions of desired outcomes, offer guidance on the tools used to measure SDM in the multitude of contexts in which it occurs, evaluate the impact of SDM policy initiatives over time, review that impact at regular intervals, and revise SDM measurement tools as needed.

Keywords: Cancer patients; Health policy; Medical research; Quality of care; Shared decision making; ethics; patient engagement; public health.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Decision Making, Shared*
Delivery of Health Care*
Humans
Organizational Policy*
Patient Participation*

Grants and funding

P30 DK092949/DK/NIDDK NIH HHS/United States