Patients involved in medical decisions

In shared decision making, the health care professional does not decide on his or her own which treatment will be administered, but the professional and the patient decide together.

Trudy van der Weijden, professor of Implementation of Clinical Practice Guidelines at Maastricht University: “We are very pleased to have been able to get the conference on this theme to Maastricht. It is a major international event with almost 300 participants from over 20 countries and from many different fields: physicians, nursing scientists and nurses, health scientists, ethicists, epidemiologists, health psychologists and, for the first time, patient representatives in four different countries will participate. We are very proud of this. They can make an important contribution to the discussion.”

The conference attracts a lot of attention in the international medical world and in the press. And that is necessary, according Van der Weijden: “We must spread the message, because it is a movement that deserves to be in the spotlight. When it is applied well, both doctors and patients will benefit from shared decision making.”

What concrete changes does this bring to doctor-patient consultations? “Doctors and patients both have an active role in shared decision making” van der Weijden explains. “Patients can inform themselves about treatment options, through the help of so-called decision aids for example. Health care professionals should offer the decision aids, explain them in understandable language, and listen carefully to the considerations of the patient. National clinical practice guidelines serve as tools and resources to create more consistency in the treatments prescribed by doctors, but they should not be used dogmatically. Doctors should be able to have a flexible interpretation of the guidelines and tailor it to the patient. Shared decision making can provide a framework for that process.”

“Deliberation on whether or not to start a treatment, a screening or diagnostic test is done together in a joint decision making process. In this way the patient can take part in deciding whether he or she wishes to be treated according to the first choice option as described in the guidelines themselves, choose an alternative treatment option, or even choose to do something completely different from what is in the guidelines. This is important especially when it comes to deciding between extending life and quality of life. For example, in the treatment of prostate cancer a high dose of radiotherapy has the greatest chance of prolonging life, but also causes unpleasant side effects such as incontinence and impotence. Radiotherapy with a lower dose will prolong life a little less, but there is a much smaller chance of unpleasant side effects. Faced with these dilemmas, everyone makes different choices depending on their personal situation and values,” according to Van der Weijden.

The 2011 International Shared Decision Making Conference will be held from 19 to 22 June at the Crowne Plaza Hotel in Maastricht. For more information visit http://www.isdm2011.org

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