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ISBN: 9780199546275

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Shared Decision-Making In Health Care Achieving Evidence-Based Patient Choice

Achieving evidence-based patient choice

Second Edition

Adrian Edwards, Glyn Elwyn


When the first edition of this book came out in 2001 (under the title Evidence-based Patient Choice: Inevitable or Impossible?), it examined the emerging themes of patient choice and clinical decision-making, and looked at how these might develop in the future. Since then, these issues have become even more topical. Evidence-based medicine is deeply ingrained in the practice of modern medicine, whilst patient choice is increasingly high on the political agenda. But can the two trends co-exist? 'Shared decision-making' has developed in response to the sometimes uneasy relationship between a patient's right to have input into their treatment options, and a clinician's responsibility to provide the best evidence-based health care.

This timely book explores shared decision-making by examining from practical and theoretical perspectives what should be part of the decision-making process, what the benefits and potential difficulties are when it is attempted, and examples of how this is achieved in real health care practice for several health conditions. Finally, it also examines how this type of health care is likely to become more common place in the future.

Practical case studies from actual health care practice, covering both general and specific conditions, offer tangible examples for both patients and doctors

Practical discussion for clinicians covering skills, competences, teaching, and training exemplifies the practical and specific ways of adopting the ethos and acquiring skills for clinicians, including also working in multi-disciplinary teams

Theoretical perspectives from several social science disciplines, including psychology, sociology, ethics, and economics, analyse the strengths and weaknesses underlying this approach to health care

Shows areas where application is growing in new / increasingly important policy areas, such as informed choice and consent, health literacy, and the 'expert patient programmes'

Documents the current situation and likely future developments, to help plan and deliver policy initiatives

The first edition of this book was highly commended in the Primary Care category of the BMA Book Awards 2002

1: Adrian Edwards & Glyn Elwyn: Shared decision-making in healthcare: achieving evidence-based patient choice
2: Margaret Holmes-Rovner & David Rovner: International collaboration in promoting shared decision making: a history and prospects
3: Vikki Entwistle: Patient involvement in decision-making: the importance of a broad conceptualisation
4: France Légaré & Dawn Stacey: Shared decision making: the implications for healthcare teams and practice
5: Dawn Stacey, France Legare & Jennifer Kryworuchko: Evidence-based healthcare decision making: roles for health professionals
6: Hazel Thornton: Evidence-based health care: what roles for patients?
7: Hilary L. Bekker: Using decision-making theory to inform clinical practice
8: Tim Rapley & Carl May: Evidence and risk: the sociology of health care grappling with knowledge and uncertainty
9: Søren Holm & Myfanwy Davies: Ethical issues around evidence-based patient choice and shared decision-making
10: Ivar Sonbo Kristiansen: The economics of shared decision-making
11: Amiram Gafni & Cathy Charles: The physician-patient encounter: an agency relationship?
12: Madeleine J. Murtagh: Decision-making, power and the doctor patient relationship
13: Theresa M. Marteau: Informed choice: a construct in search of a name
14: Anne Rogers: Developing expert patients
15: Michelle Edwards, Sophie Hill & Adrian Edwards: Health literacy - achieving consumer 'empowerment' in health care decisions
16: Marla L. Clayman & Gregory Makoul: Conceptual variation and iteration in SDM: the need for clarity
17: Glyn Elwyn & Cathy Charles: Shared decision-making: from conceptual models to implementation in clinical practice
18: Hilary Llewellyn-Thomas: Values clarification
19: Adrian Edwards: Risk communication - making evidence part of patient choices
20: Glyn Elwyn, Benjamin Elwyn & Talya Miron-Shatz: Measuring 'decision quality': irresolvable difficulties and an alternative proposal
21: Karen R. Sepucha & Albert G. Mulley: A practical approach to measuring the quality of preference-sensitive decisions
22: Angela Coulter: What's happening around the world?
23: Dennis J. Mazur: Medico-legal aspects of evidence-based choice and shared decision-making
24: Paul Kinnersley & Adrian Edwards: Helping consumers with their information needs
25: Lisa M. Schwartz, Steven Woloshin & H. Gilbert Welch: Helping consumers to know their chances
26: Hilda Bastian, Marco Knelangen & Beate Zschorlich: Making information available to patients and the general public: the example of 'Informed Health Online' from Germany
27: Annette M. O'Connor & Adrian Edwards: The role of decision aids in promoting evidence-based patient choice
28: Dawn Stacey, Carol Bennett, Anton Saarimaki, Sara Khangura, Karen Eden & Nananda Col: How effective are patient decision aids?
29: Marie-Anne Durand & Glyn Elwyn: Examining the theoretical foundation of decision support technologies
30: Anna Winterbottom & Hilary Bekker: Should patient stories be used in decision aids?
31: Elizabeth Murray: The role of internet-delivered interventions in self-care
32: Richard Thomson: Decision analysis - utility for everyday use?
33: Glyn Elwyn & Annette O'Connor: The International Patient Decision Aids Standards (IPDAS) Collaboration: the checklist, the instrument and next steps
34: Hilary Llewellyn-Thomas: The decision research lab
35: Alan Montgomery: Decision aids for preventing cardiovascular disease
36: Sascha Köpke & Ingrid Mühlhauser: Decision aids in multiple sclerosis
37: Anne Kennedy: Decision aids / shared decision-making in Inflammatory Bowel Disease
38: Daniela Simon, Celia E. Wills & Martin Härter: Shared decision-making in mental health
39: Joanne Protheroe: Decision aids and shared decision-making in menorrhagia
40: Matthias Lenz & Ingrid Mühlhauser: Decision aids in diabetes
41: Jeff Belkora: Promoting critical reflection in breast cancer decision-making
42: Anne M. Stiggelbout & J. Kievit: Aneurysms of the abdominal aorta
43: Rhodri Evans: From leaflets to edutainment: the evolution of PSA decision support tools
44: Michael J. Barry: Decision support in the treatment of prostate conditions
45: Alexandra Barratt & Joan Austoker: Decision aids and shared decision-making in mammography screening
46: Carmen Lewis & Michael Pignone: Decision aids to promote shared decision-making for colorectal cancer screening
47: Trudy van der Weijden, Ben van Steenkiste & Marije S. Koelewijn-van Loon: Shared decision-making in cardiovascular risk management: experiences and challenges
48: Lyndal Trevena & Julie Leask: Decision aids for MMR vaccination
49: Clara L. Gaff & Bettina Meiser: Supporting decisions in clinical genetics
50: Christopher Price: A Devils' Advocate: do patients really want shared decision-making?
51: France Légaré, Stéphane Ratté, Karine Gravel & Ian D. Graham: Barriers and facilitators to implementation of shared decision making
52: Carl May, France Légaré, Trudy van der Wiejden & Glyn Elwyn: Understanding factors that retard the normalization of decision-support technologies
53: Angela Towle & William Godolphin,: Education and training of health care professionals
54: Glyn Elwyn, Annette O'Connor, Dominick Frosch, Bob Volk & Deb Feldman-Stewart: Decision aids and beyond: the next decade of decision support technologies...
55: Donald W. Kemper: Information therapy: tomorrow's promise is happening today - an example from the commercial sector
56: Glyn Elwyn & Adrian Edwards: "It's what we do around here": shared decision-making as a future organisational competence

Edited by Adrian Edwards , Professor in General Practice, School of Medicine, Cardiff University, UK

Glyn Elwyn , Research Professor in Primary Care, School of Medicine, Cardiff University, UK

Adrian Edwards is Professor of General Practice at the Department of Primary Care and Public Health at Cardiff University. He is also a part-time general practitioner in Cwmbran, Gwent, South Wales seeing about 80 patients per week, and holds a visiting chair at the University of South Denmark in Odense. His two main research interests are in risk communication as part of shared decision-making, and in quality improvement in primary care. Among the former, research work has included the development and evaluation of training for doctors in risk communication approaches, and simple decision aids for use in consultations. More recently this has focused on development of interactive decision aids that might be used outside consultations. Other more 'fundamental' work is looking at the notion and application of Health Literacy initiatives that may underpin patient involvement in shared decision-making. Glyn Elwyn is a primary care clinician who has research interests in shared decision-making, decision support technologies, risk communication and the integration of health informatics into clinical practice. He has published 150 peer-reviewed articles. He was appointed as one of the inter-school Link Chairs at Cardiff University in May 2005, and leads the Clinical Epidemiology Interdisciplinary Research Group at the School of Medicine (2007). In collaboration with Professor Adrian Edwards, he convenes a research group on decision-making and the development of web-based interactive decision support materials (see www.prosdex.com, www.amniodex.com, www.bresdex.com). He is involved in the supervision of 10 PhD students. He holds a visiting chair position at 'IQ', the Scientific Institute for Quality of Healthcare, Radboud University & Medical Centre, Nijmegen, The Netherlands.He co-leads the International Patient Decision Aids Standards Collaboration with Professor Annette O'Connor, Ottawa, Canada.

`Review from previous edition This well designed book is clear, accessible and, as one would expect from the title, evidence-based . . . I think this is a great book that challenges clinicians and others working in health care to develop and adapt to a rapidly changing and demanding world. Can we do it with support from patients? The answer is in the book! ' Family Practice, Vol 19, No 3

`Before the last chapter, evidence-based patient choice could still be an option. After it, there's simply no argument. ' EBPC on Bandolier

`This impressive edited book . . . is truly excellent . . . essential reading for all those interested in patient involvement and evidence-based health-care. ' Health Expectations, 5