my understanding is that the words "decision making" are used with a
different meaning in clinical and shared decision making.
In the latter the refer to the way information are processed, while in
the former to the agents involved in the process (maybe "decision
taking"), so they don't seem neither conflicting nor overlapping
(although, of course, they are concurrent)
According to its advocates, the place of shared DM is after the problem
has been defined and before the management plas has been decided upon
(Elwin, Brit J Gen Pract, 1999). I don't agree completely (I think that
sharing should also be part of the definition of the problem), but it
seems clear that the process that we call "clinical decision making" has
already started at that point, and although some form of shared process
can be acting in the interaction, it mostly happen independently in the
different actors (i.e. the patient and the health professional)
Where shared decision making seems to clash more with the current EBM
paradigm, is on its requirement for providing choices rather than
focusing on the "best" one.
I think that the clash is only apparent, because eventually a "best
choice" should be selected anyway: the difference being that the choice
should the result of a shared judgment rather of the judgment of the
professional alone. Still, integrating it in the current practice of EBM
requires some changes in the way most of us see its duties, and on
the way many EB-guidelines are written.
piersante sestini
Maskrey Neal wrote:
>
> I’m finding it best to draw a distinction between clinical (or
> clinician) decision making and shared decision making. Whilst the
> cognitive approach is common and biases affect both, the power of
> clinical training in the former and the importance of consultation
> skills in the latter mean a somewhat artificial distinction helps loads
> with constructing the data into something meaningful, and making the
> whole understandable by others. For me the third domain is information,
> where we in EBM have so far spent most time and effort. Quite right too,
> but if we want to increase utility we need to some work at the problems
> of clinical decision making and shared decision making might help.
>
>
>
> Bw
>
>
>
> /Neal/
>
>
>
> Neal Maskrey
>
> NPC
>
> Liverpool UK
>
>
>
|