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Glyn Elwyn. Nijmegen, The Netherlands: WOK, 2001, £10.00, pp 221. ISBN 90 76316 12 0
Involving patients in making decisions about their medical care has become widely advocated. Attractive to patients, policy makers and clinicians alike, research has suggested it may go further than enhancing autonomy by improving outcomes, decreasing treatment costs, and increasing compliance and satisfaction.
As a medical student doing research into patient preferences for involvement in decision making, I found Glyn Elwyn's PhD thesis, supervised by the Centre for Quality of Care Research at the Universities of Nijmegen and Maastricht, very stimulating. While much of the content has been published elsewhere, a strength of this book is the logical development of ideas revealed when reading the papers together and the insight this enables. The publication of the thesis in this form will allow greater accessibility to the important and interesting work he has done. The clear conceptualisation of shared decision making would be a good introduction to anyone interested in, but unfamiliar with, the theory.
An extensive literature review emphasises the lack of an existing adequate measure of the extent to which health professionals involve patients in medical decisions, leading to Elwyn's development of the OPTION (observing patient involvement) scale. This is fully described and the manual included which is extremely useful for anyone wishing to conduct the further research needed in clinical settings. This tool will allow the evaluation of shared decision making in practice and will enable its implications to be better understood. It is intended to be generic enough for use in all types of consultation.
While the research was all conducted in a general practice setting—an obvious limitation to its generalisability—it will doubtless inspire research in secondary care since it raises issues which are relevant to most clinicians. An example of this is the development of interpersonal skills and training in risk communication to increase patient involvement in decision making.
The dynamic nature of this work is reflected by the different research methods used, both quantitative and qualitative, which holds the reader's interest throughout. Some were used more effectively than others—for example, the feasibility of shared decision making in consultations in which there is conflict between doctor and patient was less well evaluated, although the issues raised from examining the consultations in more depth were interesting and revealed some of the difficulties associated with this technique.
By successfully increasing understanding from a clinician perspective while being sensitive to remaining challenges, Elwyn has developed an excellent basis from which medical education could facilitate shared decision making and establish it as part of routine clinical practice.
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