Shared Decision Making — The Pinnacle of Patient-Centered Care (NEJM)

Shared Decision Making — The Pinnacle of Patient-Centered Care
Michael J. Barry, M.D., and Susan Edgman-Levitan, P.A.

N Engl J Med 2012; March 1, 2012

"Nothing about me without me."

— Valerie Billingham, Through the Patient's Eyes, Salzburg Seminar Session 356, 1998


Caring and compassion were once often the only “treatment” available to clinicians. Over time, advances in medical science have provided new options that, although often improving outcomes, have inadvertently distanced physicians from their patients. The result is a health care environment in which patients and their families are often excluded from important discussions and left feeling in the dark about how their problems are being managed and how to navigate the overwhelming array of diagnostic and treatment options available to them.

In 1988, the Picker/Commonwealth Program for Patient-Centered Care (now the Picker Institute) coined the term “patient-centered care” to call attention to the need for clinicians, staff, and health care systems to shift their focus away from diseases and back to the patient and family.1 The term was meant to stress the importance of better understanding the experience of illness and of addressing patients' needs within an increasingly complex and fragmented health care delivery system.

The Picker Institute, in partnership with patients and families, conducted a multiyear research project and ultimately identified eight characteristics of care as the most important indicators of quality and safety, from the perspective of patients: respect for the patient's values, preferences, and expressed needs; coordinated and integrated care; clear, high-quality information and education for the patient and family; physical comfort, including pain management; emotional support and alleviation of fear and anxiety; involvement of family members and friends, as appropriate; continuity, including through care-site transitions; and access to care.1 Successfully addressing these dimensions requires enlisting patients and families as allies in designing, implementing, and evaluating care systems.

This concept was introduced in the landmark Institute of Medicine (IOM) report Crossing the Quality Chasm 2 as one of the fundamental approaches to improving the quality of U.S. health care. The IOM defined patient-centered care as “care that is respectful of and responsive to individual patient preferences, needs, and values” and that ensures “that patient values guide all clinical decisions.” This definition highlights the importance of clinicians and patients working together to produce the best outcomes possible.

http://www.nejm.org/doi/full/10.1056/NEJMp1109283?query=health-policy-and-reform

NEJM.org Copyright © 2012 Massachusetts Medical Society. All rights reserved.