When to engage in shared decision making?

By | June 10, 2020

Very good article about shared decision making was just recently published in the Canadian Family Physician. Authors discuss when shared decision making is the best option.

Table 1 in their article is the most important. It gives a clear and concise description when SDM should be considered.

First option states: There are at least 2 medically valid options with a balance between benefits and harms. As always the examples include different disease screening and pharmacological primary prevention.

As I´ve highlighted many times earlier, similar situation is faced everyday in orthopaedics and traumatology: benefits and harms in operative and nonoperative treatment are in balance.

True and objective balance may not always be present but situation could more like the second option in the article: In specific circumstances even if
the balance between benefit and harms is usually not in equipoise
. They give an example which says: The balance between benefits and risks is different for a particular patient. This is the most important. While clinical equipoise may not always obvious, patient preferences and expectations are those aspects which creates these situations, namely clinical equipoise.

Article includes also very nice work flow framework when patients´request are not aligned with surgeons view.

SDM is becoming increasingly relevant in orthopaedics. Article like this gives a lot of fundamental aspects how to implement SDM in orthopaedics. We urgently need studies which investigate patient´s perspectives in the treatment of common orthopaedic conditions such as clavicle fracture and Achilles tendon rupture.

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