National Institute for Health Care Reform. (2011). Policy Options to Encourage Patient- Physician Shared Decision Making. Wasington, DC: O’Malley, A.S., Carrier, E.R., Docteur, E., Schmerling, A.C., & Rich, E.C. Retrieved from http://www.nihcr.org/Shared-Decision-Making.pdf.
“Major discrepancies exist between patient preferences and the medical care they receive for many common conditions. Shared decision making (SDM) is a process where a patient and clinician faced with more than one medically acceptable treatment option jointly decide which option is best based on current evidence and the patient’s needs, pref- erences and values. Many believe shared decision making can help bridge the gap between the care patients want and the care they receive. At the same time, SDM may help con- strain heath care spending by avoiding treatments that patients don’t want. However, barriers exist to wider use of shared decision making, including lack of reimbursement for physicians to adopt SDM under the existing fee-for-service payment system that rewards higher service volume; insufficient information on how best to train clinicians to weigh evidence and discuss treatment options for preference-sensitive conditions with patients; and clinician concerns about malpractice liability. Moreover, challenges to engaging some patients in shared decision making range from low health literacy to fears they will be denied needed care. Adding to these challenges is a climate of political hyperbole that stifles discussion about shared decision making, particularly when applied to difficult end- of-life-care decisions.”