Shared decision-making is the latest gold standard in medicine, but some experts worry it’s veering too close to full patient autonomy, Medscape reported Sept. 14.
“We’ve swung all the way to the other end, which is actually an inaccurate understanding of what shared decision-making is,” Andrea Landi, MD, a clinical medical ethicist and associate professor at the University of Louisville in Kentucky, told Medscape. “We’re missing the mark when it comes to autonomy … we worry that providing a recommendation is actually paternalism.”
Here is what to know.
1. Medicine started moving away from paternalism in the ’70s and has leaned into patient autonomy to build informed consent, transparency and empathy. However, some patients may feel abandoned when given autonomy.
“For families to have to make such a heart-wrenching decision by themselves is really hard,” Amy Trowbridge, MD, an associate professor at the Seattle-based University of Washington School of Medicine, told Medscape. “I have seen families be harmed by feeling like they are the ones who have chosen to stop life support on their babies, and carrying guilt around that because they are the ones who had to make that decision.”
2. A review published in Health Communications found clear delivery, active listening and empathy were associated with patient trust. They also found paternalistic styles didn’t always harm trust, and aided in shared decision-making in some situations, including emergency care, serious illness and end-of-life decisions.
3. Experts are encouraging physicians to reclaim the middle group: beneficence, or the moral duty to act in the patient’s best interest.
Shared decision-making “not only respects autonomy of patients but also recognizes the importance of beneficence — that doctors want to do good for patients,” Peter Angelos, MD, PhD, a professor of surgery and director of the MacLean Center for Clinical Ethics at the University of Chicago, told Medscape. “With this principle, we feel a responsibility to find the right diagnosis and make the right recommendation.”
4. A Netherland’s study found some young physicians lean more into paternalism out of anxiety that patients will not choose the evidence-based approach.
5. Hospitals and physicians can improve beneficence by discovering their patients’ communication style preferences, physicians taking an evolving role in the decision-making process as the conversation advances and engaging in more active listening.
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