Another ‘shared decision-making’ rant!

I’ve ranted before about what I see as the inappropriateness of the term ‘shared decision-making’ in medical circles. Calling a decision a ‘shared decision’ implies that the practitioner gets a say in what the person chooses. Yet when it comes to adults, and unless there are unusual and extenuating circumstances, decision-making is entirely the remit of the person whose body or health care is under discussion. Those people may consult a practitioner for information, and they might even ask for advice, but the decision is theirs.

The need for this distinction was brought home to me even more clearly by a recent paper on this topic, “Are Providers Prepared to Engage Younger Women in Shared Decision-Making for Mammography?” (Martinez et al 2017). Putting aside the fact that I would use different language (for I understand that many authors simply follow convention) it is the results of this study which really got my attention, and the implications that they have for people who need to make important decisions about health. Which is, when you think about it, pretty much all of us.

Of 220 primary care providers who filled out an online survey to assess their knowledge of the benefits and harms of mammography screening:

  • 90% underestimated the risk of additional imaging
  • 82% underestimated the risk of breast biopsy
  • 62% percent correctly estimated screening’s impact on mortality (which means that 38% didn’t).
  • The majority (83%) said they believed in shared decision-making for mammography, yet most (77%) spent less than 5 minutes with discussing screening with women.
  • Of those who said they believed in shared decision-making, only 10% had key mammography knowledge and also felt highly competent at engaging women in screening discussions. (Martinez et al 2017).

I don’t think there’s much I can say to follow that except perhaps to share a link to the Cochrane review on this topic, which shares the statistics on both the benefits and the harms of mammography for anyone who would like to know more about this. But what one would decide about mammography screening isn’t really the point here. The point is to urge more people to realise that these are decisions for the person who is affected by them (and who will be affected by the potential consequences of them) to make. It is also important to understand that there is always more than one way to look at health (and birth) decisions and that there can be huge value in thinking critically about the source of information, no matter whether it is a so-called expert, a website like this one, a piece of research or a story or book based on someone’s personal experience. There is no one right path, but it might be that engaging with the issues can help us find the path that is most right for us at that time.


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photo credit: siaronj three way split via photopin (license)