Shared decision making in medicine: the influence of situational treatment factors.
OBJECTIVE
Although shared decision making (SDM) has become increasingly important in bioethical discussions and clinical practice, it is not clear in which treatment situations SDM is suitable. We address this question by investigating social norms on the appropriateness of SDM in different situations.


METHODS
We conducted qualitative expert interviews with patients, general practitioners, and health administration and research professionals.


RESULTS
SDM was considered to be most important in severe illness and chronic condition. Furthermore, SDM was indicated to be required if there is more than one therapeutic option, especially if it is not clear which option is best. Interviewees classified end-of-life decisions and decisions about prevention as those that primarily should be made by informed patients. On the other hand a paternalistic decision was considered most appropriate in emergency situations and when the patient does not want to participate in decision making.


CONCLUSIONS
This study demonstrates that multiple situational factors and their interactions must be considered regarding the scope of SDM in medical consultation.


CONCLUSIONS
Research addressing this question will help physicians adjust their consultation style and allow implementations of SDM and decision aids to be tailored more appropriately to complex treatment situations.
Müller-Engelmann
Meike
M
Department of Family Medicine, University of Marburg, Germany. meike.mueller-engelmann@staff.uni-marburg.de
Keller
Heidi
H
Donner-Banzhoff
Norbert
N
Krones
Tanja
T
D001675:Bioethics; D003142:Communication; D003657:Decision Making; D005260:Female; D058005:General Practitioners; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010358:Patient Participation / Q000379:methods* / Q000523:psychology; D010817:Physician-Patient Relations; D036301:Qualitative Research; D011795:Surveys and Questionnaires