title: Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model.
abstract: In this paper we revisit and add elements to our earlier conceptual framework on shared treatment decision-making within the context of different decision-making approaches in the medical encounter (Charles, C., Gafni, A., Whelan, T., 1997. Shared decision-making in the medical encounter: what does it mean? (or, it takes at least two to tango). Social Science & Medicine 44, 681 692.). This revised framework (1) explicitly identifies different analytic steps in the treatment decision-making process; (2) provides a dynamic view of treatment decision-making by recognizing that the approach adopted at the outset of a medical encounter may change as the interaction evolves; (3) identifies decision-making approaches which lie between the three predominant models (paternalistic, shared and informed) and (4) has practical applications for clinical practice, research and medical education. Rather than advocating a particular approach, we emphasize the importance of flexibility in the way that physicians structure the decision-making process so that individual differences in patient preferences can be respected.
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont., Canada. charlesc@fhs.csu.mcmaster.ca
authors.forename: C
authors.initials: C
authors.lastname: Charles
authors.forename: A
authors.initials: A
authors.lastname: Gafni
authors.forename: T
authors.initials: T
authors.lastname: Whelan
mesh_terms: D002170:Canada; D003657:Decision Making; D006302:Health Services Research; D006801:Humans; D008962:Models, Theoretical; D010358:Patient Participation; D010817:Physician-Patient Relations