SDM-I

Call for Papers

Patients, when becoming ill and asking for help, present not as subjects, objects or complex biological machines, but rather as persons. They possess a narrative of illness, values, preferences, psychological and emotional needs, existential and spiritual complexities, worries, anxieties, fears, goals, psychosocial and psychosexual/relational dysfunctions, work and economic stressors – and a great deal more. It stands to reason that any approach to care that can be considered adequate, let alone optimal, must surely take all such factors into full and proper account, avoiding a concentration simply (and reductively) on the biological body alone. Rather, clinicians and carers, within the modern health and social care systems in which they operate, must strive to attend to the person of the patient as an integral whole. It is in this context that the value and necessity of shared decision-making becomes, we assert, immediately clear.

At its simplest, shared clinical decision-making (SDM) is a process through which both patient and clinician (or patient and family and clinicians) share the decision-making process in the face of multiple investigative and treatment options. The concept is not new, with the term ‘shared decision-making’, as an ethical imperative, having been first employed by Veatch in 1972. Since that time, the evolution of SDM has progressed slowly but surely, accelerating, over the last 10 years or so, as a function of the influence of major SDM work programmes, such as those of the Dartmouth Institute for Health Policy and Clinical Practice, USA, and elsewhere. At the time of writing, SDM is now well recognised as a central ethical and methodological component of the person-centered approach to health and social care, with increasing interest in how the basic tools of SDM, such as patient education, option grids and decision aids (etc), can be shifted, against barriers, from experimental clinical settings, into routine, operational clinical care.