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When patient-centred care is worth doing well: informed consent or shared decision-making
  1. Marleen Kunneman1,2,
  2. Victor M Montori2
  1. 1Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  2. 2Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Victor M Montori, Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, 200 1st Street SW, Rochester MN 55905, USA; montori.victor{at}mayo.edu

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High quality care is patient-centred.1 Efforts to promote patient-centred care in clinical practice should improve quality. Both shared decision-making (SDM) and the process of obtaining informed consent could be expressions of patient-centred care—to the extent that they respond to the advocates' call for ‘nothing about me without me’. In this issue of BMJ Quality and Safety, Shahu et al2 discuss variations in the quality of informed consent procedures, which could, in their view, fail to support patient-centred care in general, and SDM specifically.

Readers interested in advancing this domain of quality may, therefore, be interested in improving the quality of informed consent procedures and promoting the implementation and routine use of SDM. But are these similar practices? Is informed consent a lesser version of SDM, with SDM the ideal expression of patient autonomy and involvement? Or are these different in purpose, process and outcomes?

Informed consent establishes a minimal legal standard in which (1) clinicians disclose the risks, benefits and alternatives of a proposed treatment or procedure and (2) people accept or reject this procedure that has been identified to be the most relevant for them.3 The patient involvement is limited to accepting or rejecting a proposed path. This ‘choice’ is implemented late in the trajectory of the patient and in the process of making decisions about care. By the time the process becomes recognisable to the parties and formal, often at the time of reviewing and signing an informed consent document, the decision to go forward has been made and is being implemented, perhaps even without active patient involvement.

Why then offer choice in this way to patients? The motivation …

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