Shared Decision-Making in Diabetes Care
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Shared decision-making (SDM) is a collaborative process by which patients and clinicians work together in a deliberative dialogue. The purpose of this dialogue is to identify reasonable management options that best fit and addresses the unique situation of the patient. SDM supports the patient-centered translation of research into practice. SDM also helps implement a core principle of evidence-based medicine: evidence is necessary but never sufficient to make a clinical decision, as consideration of patient values and context is also required. SDM conversations build on a partnership between the patient and the clinician, draw on the body of evidence with regard to the different treatment options, and consider options in light of the values, preferences, and context of the patient. SDM is appropriate for diabetes care because diabetes care often requires consideration of management options that differ in ways that matter to patients, such as the way in which they place significant demands on patient’s life and living. In the last decade, SDM has proven feasible and useful for sharing evidence with patients and for involving patients in making decisions with their clinicians. Health care and clinical policies advocate SDM, but these policies have yet to impact diabetes care. In this paper, we describe what SDM is, its known impact on diabetes care, and needed work to implement this patient-centered approach in the care of the millions of patients with diabetes.
KeywordsShared decision-making Diabetes Evidence-based medicine Decision aids
For the last decade, the Patient Advisory Group, a group of patients with diabetes from the community, has met with investigators of the KER Unit at Mayo Clinic to ground their work on what matters to patients. The insights developed here would not have been possible without their generous contribution to the science of health care. Thanks to Michael R. Gionfriddo, Aaron Leppin, M.D., and LeBlanc, Annie, Ph.D. from the KER Unit for their valuable assistance in the manuscript preparation.
Compliance with Ethical Standards
Conflict of Interest
Victor M. Montori and Ian Hargraves work in the KER Unit, a research laboratory of the Mayo Clinic that designs, evaluates, implements, and disseminates shared decision-making tools for patients with diabetes. These tools are made available for free and there is no income that results from these to the authors, other investigators within the KER Unit, or anyone else. Shrikant Tamhane and Rene Rodriguez-Gutierrez are trainees at the KER Unit. Otherwise, these authors declare no conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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