Clinicians have an ethical imperative to share important decisions with patients, and patients have a right to be equal participants in their care, according to a group of experts.
In December 2010, 58 people from 18 countries attended a Salzburg Global Seminar to consider the role patients can and should play in health care decisions. They published a statement urging patients and clinicians “to work together to be co-producers of health,” according to a press release.
It comes as the government in England finalizes plans to give people more say and more choice over their care than ever before.
The experts argue that much of the care patients receive is based on the ability and readiness of individual clinicians to provide it, rather than on widely agreed standards of best practice or patients’ preferences for treatment.
They also say that clinicians are often slow to recognize the extent to which patients’ wish to be involved in understanding their health problems, in knowing the options available to them, and in making decisions that take account of their personal preferences.
As such they call on clinicians to stimulate a two-way flow of information with patients, to provide accurate information about treatment, to tailor information to individual patient needs and allow them sufficient time to consider their options. In turn, they urge patients to ask questions and speak up about their concerns, to understand that they have a right to be equal participants in their care, and to seek and use high-quality health information.
They also call on policymakers to adopt policies that encourage shared decision making and to support the development of skills and tools for shared decision making.
One of the signatories, professor Glyn Elwyn from Cardiff University, says that despite considerable interest in shared decision making, and clear evidence of benefit, implementation within the NHS “has proved difficult and slow.”
Angela Coulter from the Foundation for Informed Medical Decision Making agrees and points to recent evidence showing that most patients want choice, but that many clinicians remain ambivalent or antagonistic to the idea. She believes the government’s new commitment to shared decision making presents a challenge to entrenched attitudes and the need for big change in practice styles.