Shared decision making in healthcare

摘要

Traditionally the patient-clinician relationship was paternalistic, in which the clinician made the decisions on behalf of the patient. However, there has been a paradigm shift away from this type of encounter, and a drive towards more patient-centred care, whereupon the patient is more empowered, informed, and autonomous - a move from a 'paternalistic' to a 'mutualistic' relationship. Recently, there has been an explosion of interest and research in shared decision making (SDM), which is at the heart of patient-centred care. SDM is a two-way process wherein both the patient and the clinician share information and the responsibility for decision making. It is appropriate in most healthcare encounters, as the majority of treatment decisions involve options, even if one of these is doing nothing.