Comments on: Shared Decision Making in Health Care http://psychinaction.wordpress.com/2008/04/28/shared-decision-making-in-health-care/ A place for science and people to meet... Sat, 06 Jun 2009 16:39:11 +0000 http://wordpress.com/ hourly 1 By: Emily http://psychinaction.wordpress.com/2008/04/28/shared-decision-making-in-health-care/#comment-35 Emily Sat, 31 May 2008 04:42:01 +0000 http://psychinaction.wordpress.com/?p=11#comment-35 Hi Tage, Perhaps I should clarify. Shared decision making doesn't imply that all of a sudden the patient is the only one in charge of making a decision. It's a way to consider information that the doctor can't know without asking the patient-- for example, in the case of screening and treatment for prostate cancer (which can be hugely invasive with big side effects), for some patients, impotence may be a major concern, while for others the stress of worrying about an illness that may or may not come would be a bigger concern. Doctors can elicit this type of information and present the possible consequences of various treatment choices (when there is not one clear-cut solution), and can also explore the extent to which individuals want to be involved in such decisions. Re: the burden falling on moms, I agree that this is a problem in our society, and one that is not specific to this issue. The BC Centre of Excellence for Women's Health (www.bccewh.bc.ca) does a lot of cool work around how changes in health policy impact men and women differently. Hi Tage, Perhaps I should clarify. Shared decision making doesn’t imply that all of a sudden the patient is the only one in charge of making a decision. It’s a way to consider information that the doctor can’t know without asking the patient– for example, in the case of screening and treatment for prostate cancer (which can be hugely invasive with big side effects), for some patients, impotence may be a major concern, while for others the stress of worrying about an illness that may or may not come would be a bigger concern. Doctors can elicit this type of information and present the possible consequences of various treatment choices (when there is not one clear-cut solution), and can also explore the extent to which individuals want to be involved in such decisions.

Re: the burden falling on moms, I agree that this is a problem in our society, and one that is not specific to this issue. The BC Centre of Excellence for Women’s Health (www.bccewh.bc.ca) does a lot of cool work around how changes in health policy impact men and women differently.

]]> By: tagerai http://psychinaction.wordpress.com/2008/04/28/shared-decision-making-in-health-care/#comment-27 tagerai Fri, 30 May 2008 17:14:52 +0000 http://psychinaction.wordpress.com/?p=11#comment-27 Maybe. But my guess is that shared decision making would be very bad in practice. The key has to do w/the decision aids you mentioned at the end. A lot of us who work on the psychology of choice tend to worry that when you give people more options, they feel like they have to take advantage of them, even if it will become really stressful. So, in the past, you used to go to your doctor, and your doctor said I know what to do, and you did it. Maybe it didn't work out, maybe it did, but it was out of your hands. Nowadays, patients are getting more freedom to partake in the decision making process. Potentially, this allows them to get the best treatment possible. More likely, patients carry tons of biases, have trouble understanding base rates, are overconfident, rely too much on their intuitions which are based on particularly memorable experiences rather than accurate reflections, and will push for decisions that conflict with the doctor's wishes, and b/c the doctor is worried about getting sued, they'll go w/the patients wishes. Beyond biases in judgment, shared decision making means experiencing more psychological blame if something goes wrong. In one study, citations eluding me at the moment, people were asked if they would like to have a lot of say in their treatment if they ever got cancer. Most people said yes. But when you ask actual cancer patients, most say no, too stressful. Now I imagine decision aides will help. A little. But you still are left w/the question of who will do the research. My guess is its the mothers who are probably the ones getting saddled with doing all of the research and having to give all of the input on health decisions for the whole family in these cases. That's a whole lot of stress for good ol' mom. Maybe. But my guess is that shared decision making would be very bad in practice. The key has to do w/the decision aids you mentioned at the end. A lot of us who work on the psychology of choice tend to worry that when you give people more options, they feel like they have to take advantage of them, even if it will become really stressful. So, in the past, you used to go to your doctor, and your doctor said I know what to do, and you did it. Maybe it didn’t work out, maybe it did, but it was out of your hands. Nowadays, patients are getting more freedom to partake in the decision making process. Potentially, this allows them to get the best treatment possible. More likely, patients carry tons of biases, have trouble understanding base rates, are overconfident, rely too much on their intuitions which are based on particularly memorable experiences rather than accurate reflections, and will push for decisions that conflict with the doctor’s wishes, and b/c the doctor is worried about getting sued, they’ll go w/the patients wishes.
Beyond biases in judgment, shared decision making means experiencing more psychological blame if something goes wrong. In one study, citations eluding me at the moment, people were asked if they would like to have a lot of say in their treatment if they ever got cancer. Most people said yes. But when you ask actual cancer patients, most say no, too stressful.
Now I imagine decision aides will help. A little. But you still are left w/the question of who will do the research. My guess is its the mothers who are probably the ones getting saddled with doing all of the research and having to give all of the input on health decisions for the whole family in these cases. That’s a whole lot of stress for good ol’ mom.

]]> By: Science Sounds Like This » Blog Archive » Shared Decision Making in Health Care http://psychinaction.wordpress.com/2008/04/28/shared-decision-making-in-health-care/#comment-7 Science Sounds Like This » Blog Archive » Shared Decision Making in Health Care Fri, 02 May 2008 15:39:27 +0000 http://psychinaction.wordpress.com/?p=11#comment-7 [...] Recent work by Bob Kaplan and Dominick Frosch suggests that when patients and doctors work together to make decisions, everyone wins.  More… [...] [...] Recent work by Bob Kaplan and Dominick Frosch suggests that when patients and doctors work together to make decisions, everyone wins.  More… [...]

]]> By: Aids » Blog Archive » Shared Decision Making in Health Care http://psychinaction.wordpress.com/2008/04/28/shared-decision-making-in-health-care/#comment-6 Aids » Blog Archive » Shared Decision Making in Health Care Tue, 29 Apr 2008 04:57:46 +0000 http://psychinaction.wordpress.com/?p=11#comment-6 [...] Continue Reading  Posted on: Tuesday, April 29, 2008 at 12:56 am  Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site. [...] [...] Continue Reading  Posted on: Tuesday, April 29, 2008 at 12:56 am  Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site. [...]

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