Salzburg statement on shared decision making
BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d1745 (Published 22 March 2011) Cite this as: BMJ 2011;342:d1745
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
The Salzburger statement on shared decision making is an important
step towards spreading the idea of more patient participation in decision
making. To aid this process, evidence based information is crucial.
Such information is hard to get at. However, at
www.thedecisionaidcollection.nl, a multilingual comprehensive collection
of decision aids, designed to support shared decision making, can be
found. Please consider it for your patient care.
Competing interests: No competing interests
Few would disagree with the 'Salzburg statement' [1]. Perhaps the
first step to make it routine would be to make decisions 'transparent' by
linking each option to its diagnosis [2] (e.g. GTN spray 'for diagnosis
1') and linking each diagnosis to its supporting findings e.g. Diagnosis
1: Angina (Chest pain on exertion, exercise ECG findings).
This 'transparent' approach provides an internal consistency check
that minimises omission of relevant information (e.g. in referral letters
and discharge summaries). It also outlines each decision's justification
thoughtfully by using relevant evidence. It should thus increase the
quality of care as well as the quality of communication.
It is not only patients who would benefit from a 'transparent'
rationale outline but also students, other doctors and health
professionals (e.g. during handovers). They too must understand what has
been proposed so that they can participate in the subsequent decision
making process and suggest changes if necessary.
If there is a simple, succinct, updateable, transparent, written
rationale outline, then a patient can choose not to share in a decision,
talk to a friend or family member, get a second opinion, ask for a more
detailed discussion or ask to use a decision support tool. It could be
generated from a GP electronic record or as a hospital summary system.
References
1. Salzburg statement on shared decision making BMJ 2011; 342:d1745.
2. Llewelyn H, Ang HA, Lewis k, Al-Abdullah A. The Oxford Handbook of
Clinical Diagnosis, 2nd ed., Oxford University Press, Oxford, 2009
Competing interests: No competing interests
In the November 8th, 2010 issue of, "The Journal of Participatory
Medicine" Alex Jadad and I published an article, "Shifting from Shared to
Collaborative Decision Making: A Change in Thinking and Doing"
(http://bit.ly/9TyY8f).
In our article we provide a framework that will help achieve some of
the goals set out in the Salzburg Statement. For example, we suggest that
a two way flow can be accomplished by focusing on a collaborative decision
making process that is bi-directional in nature and therefore promotes
'knowledge building' as an iterative process of idea development.
We acknowledge that tailored information is a key component and
believe that electronic health records (EHR) include computer-mediated
communication (CMC) in the form of message boards or threaded discussion
forums will facilitate this goal. As the use of CMC has been demonstrated
to "level the playing field" we believe this would provide an ideal means
for patients to both voice their concerns and achieve equity. EHR can also
provide access to credible web-based information that includes knowledge
from patients and clinicians alike.
We also strongly support the evaluation of such practices. Our recent
publication with other colleagues, "Promoting and participating in online
health forums: A guide to facilitation and evaluation for health
professionals" (http://bit.ly/fNLLI5) shares some metrics and
recommendations to engage in this process.
We invite our colleagues to read these publications, provide feedback
and collaborate with us on the implementation and evaluation of this
important endeavor.
Sincerely,
Laura O'Grady, PhD
Competing interests: No competing interests
Salzburg statement: A call to health care educators too.
The "Salzburg statement" on shared decision-making puts again on the
table our responsibility to take into account patient values and
preferences in healthcare decisions.[1] Despite new models of evidence-
based decision-making acknowledge that patients' preferences rather than
clinicians' preferences should be considered first whenever it is possible
to do so, this is often neglected.[2]
If it is expected that core undergraduate curriculum in medical
schools prepare students for their future people-centered practice, we
must provide innovative and transformative learning environments to
achieve this goal.[3] This include innovative ways to teach communication
and shared decision-making competences.
There are already sets of competences proposed for the practice of
informed and shared decision-making by physicians and patients, that could
be used as frameworks for teaching, practice, and research.[4] Also
several instruments have been developed to evaluate shared decision making
among patients and health professionals.[5,6] Most of these instruments
have not been yet adapted to undergraduate medical education, and none of
this has been validated for Spanish-speaking countries. How can we expect
that our health professionals foster participatory decision-making if
these skills are not included in the intended or delivered curriculum of
medical schools?
Then we must also made a call to educators to develop, validate and
implement educative interventions to achieve the competences needed for
healthcare students to foster shared decision-making in their future
practice.
References
1. Salzburg statement on shared decision making. BMJ 2011; 342:d1745.
2. Haynes RB, Devereaux PJ, Guyatt GH. Clinical expertise in the era
of evidence-based medicine and patient choice. ACP journal club 2002; A11-
A14.
3. Frenk J, Chen L, Bhutta Z, Cohen J, Crisp N, Evans T, et al.
Health professionals for a new century: transforming education to
strengthen health systems in an interdependent world. The Lancet 2010;
376(9756):1923-1958.
4. Towle A, Godolphin W. Framework for teaching and learning informed
shared decision making. BMJ 1999; 319(7212):766-71.
5. Shields CG, Franks P, Fiscella K, Meldrum S, Epstein RM. Rochester
Participatory Decision-Making Scale (RPAD): reliability and validity.
Annals of family medicine 2005; 3(5):436-42.
6. Elwyn G, Edwards a, Wensing M, Hood K, Atwell C, Grol R. Shared
decision making: developing the OPTION scale for measuring patient
involvement. Quality & safety in health care 2003; 12(2):93-9.
Competing interests: No competing interests