Social science & medicine
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Social science & medicine · Mar 1997
Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango).
Shared decision-making is increasingly advocated as an ideal model of treatment decision-making in the medical encounter. To date, the concept has been rather poorly and loosely defined. ⋯ We suggest as key characteristics of shared decision-making (1) that at least two participants-physician and patient be involved; (2) that both parties share information; (3) that both parties take steps to build a consensus about the preferred treatment; and (4) that an agreement is reached on the treatment to implement. Some challenges to measuring shared decision-making are discussed as well as potential benefits of a shared decision-making model for both physicians and patients.
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Using the method first presented by Sullivan, the article presents results on health expectancy by level of education and gender in the late 1980s in Finland. The life tables by level of education cover the years 1986-90. Indicators of disability and poor health were based on three variables from the nationwide 1986 Survey on Living Conditions (N = 12,057): limiting long-standing illness, functional disability or poor self-perceived health. ⋯ The differences between educational categories in disability-free life expectancy were markedly larger than in total life expectancy. Life expectancy with disability was shortest among the more educated and longest among the less educated. Due to the higher life expectancy and the higher prevalence of disability among women, life expectancy with disability was longer among women than men according to all indicators.
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Social science & medicine · Mar 1997
The role of decision analysis in informed consent: choosing between intuition and systematicity.
An important goal of informed consent is to present information to patients so that they can decide which medical option is best for them, according to their values. Research in cognitive psychology has shown that people are rapidly overwhelmed by having to consider more than a few options in making choices. Decision analysis provides a quantifiable way to assess patients' values, and it eliminates the burden of integrating these values with probabilistic information. ⋯ We point out that there is no gold standard for optimal decision making in decisions that hinge on patient values. We also point out that in some such situations it is too early to assume that the benefits of systematicity outweigh the benefits of intuition. Research is needed to address the question of which situations favor the use of intuitive approaches of decision making and which call for a more systematic approach.