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Editorial
March 11, 2020

On Shared Decision-making and Informed Consent

Abstract

In the idealized concept of shared decision-making, the physician and patient comprise a collaborative clinical decision-making dyad.1 The physician contributes medical knowledge, training, experience, and judgment, whereas the patient contributes personal values and health care goals through which to evaluate how each treatment option could fulfill those goals. As partners, the patient and physician collaboratively achieve a mutually agreeable medical decision through an ongoing communication process that creates informed consent.2

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References

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Brock DW. The ideal of shared decision making between physicians and patients. Kennedy Inst Ethics J 1991;1:28–47.
2.
Bernat JL. Ethical Issues in Neurology, 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2008: 24–34.
3.
Bernat JL, Peterson LM. Patient-centered informed consent in surgical practice. Arch Surg 2006;141:86–92.
4.
McNutt RA. Shared medical decision making: problems, process, progress. JAMA 2004;292:2516–2518.
5.
Quill TE, Brody H. Physician recommendation and patient autonomy: finding a balance between physician power and patient choice. Ann Intern Med 1996;125:763–769.
6.
Lapides DA. Shared decision-making in autoimmune neurology: making decisions in the face of uncertainty. Neurol Clin Pract 2021:11;141–146.
7.
King JS, Moulton BW. Rethinking informed consent: the case for shared medical decision-making. Am J Law Med 2006;32:429–501.
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Spatz ES, Krumholz EM, Moulton BW. The new era of informed consent. Getting to a reasonable-patient standard through shared decision making. JAMA 2016;315:2063–2064.
9.
Kon AA, Davidson JE, Morrison W, Danis M, White DB. Shared decision making in intensive care units: an American College of Critical Care Medicine and American Thoracic Society policy statement. Crit Care Med 2016;44:188–201.
10.
Bernat JL. Clinical decision-making for patients with disorders of consciousness. Ann Neurol 2020;87:19–21.
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Stacy D, Légaré F, Lewis K, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2017;4:CD001441.
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Bernat JL, McQuillen MP. Physician-assisted death in chronic neurological diseases. Neurology 2017;88:1488–1489.

Information & Authors

Information

Published In

Neurology® Clinical Practice
Volume 11Number 2April 2021
Pages: 93-94

Publication History

Published online: March 11, 2020
Published in print: April 2021

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Disclosure

The authors report no disclosures relevant to the manuscript. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

Study Funding

No targeted funding reported.

Authors

Affiliations & Disclosures

James L. Bernat, MD
Department of Neurology (JLB), Geisel School of Medicine at Dartmouth, Hanover, NH.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
Editorial Board: Neurocritical Care: 2002-present (no compensation) Editorial Board: Neurology Today: 2001-2017 (no compensation) Editorial Board: The Physician's Index for Ethics and Medicine: 2011-present (compensation) Editorial Board: Multiple Sclerosis and Related Diseases: 2011-present (no compensation) Editorial Board: Neurology Clinical Practice (no compensation)
Patents:
1.
NONE
Publishing Royalties:
1.
Ethical and Legal Issues in Neurology. Elsevier, 2013 Ethical Issues in Neuorology, 3rd ed. Lippincott Williams & Wilkins, 2008. Palliative Care in Neurology. Oxford University Press, 2004.
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NIH 1. Director, Ethics Core of SYNERGY: The Dartmouth Clinical and Translational Science Institute. National Center for Advancing Translational Sciences (NIH NCATS) UL1TR001086. (10% salary provision) Terminated 11/30/2019. 2. Consultant investigator. Patient-Centered Outcomes Research Institute (PCORI) "Randomize Everyone" PI: Tor Tosteson, Ph.D. (2.5% salary provision)
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Michael P. McQuillen, MD, MA
Department of Neurology (JLB), Geisel School of Medicine at Dartmouth, Hanover, NH.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Correspondence Dr. Bernat [email protected]
Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

Author Contributions

J.L. Bernat and M.P. McQuillen: drafting/revising the manuscript and analysis or interpretation of data.

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Cited By
  1. The informed consent model is adequate for gender-affirming treatment: issues related with mental health assessment in the United States, The Journal of Sexual Medicine, 20, 5, (584-587), (2023).https://doi.org/10.1093/jsxmed/qdad019
    Crossref
  2. The mediating effect of shared decision-making in enhancing patient satisfaction with participation in cancer clinical trials, Asia-Pacific Journal of Oncology Nursing, 10, 8, (100265), (2023).https://doi.org/10.1016/j.apjon.2023.100265
    Crossref
  3. Neurology ethics at the end of life, Neuropalliative Care, Part II, (235-257), (2023).https://doi.org/10.1016/B978-0-12-824535-4.00012-4
    Crossref
  4. Gelingende Kommunikation: ethische Reflexion der normativen Grundlagen der Angehörigengespräche über Organspende, Organspende als Herausforderung gelingender Kommunikation, (155-169), (2023).https://doi.org/10.1007/978-3-658-39233-8_9
    Crossref
  5. Surgical Decision-Making for Temporal Lobe Epilepsy: Patient Experiences of the Informed Consent Process, Frontiers in Neurology, 12, (2021).https://doi.org/10.3389/fneur.2021.780306
    Crossref
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