The influence of values in shared (medical) decision making

Bettina Baldt

doi:10.1007/s00481-019-00549-y

Abstract

Definition of the problemThe Shared Decision Making model is becoming increasingly popular also in the German-speaking context, but it only considers values of patients to be relevant for medical decisions. Nevertheless, studies show that the values of physicians are also influential in medical decisions. Moreover, physicians are often unaware of this influence, which makes it impossible to control it.ArgumentsThe influence of both patients’ and physicians’ values is examined from an empirical and normative perspective. The review about the empirical data provides a necessary overview about the status quo, whereas I deduct rules for value-influenced behaviour in the decision making process in the normative approach. Therefore, different scenarios are taken into account to explore in which situations it is acceptable for physicians to let their values be part of the decision making process. The conscious use of values is only possible, when physicians are aware of their influence. To raise awareness, the best option would be to educate future physicians about it in their training. Therefore, this article provides a teaching concept for a unit that could be part of an ethics class for physicians in training. Furthermore, patient’s rights and responsibilities in the decision making process are discussed.ConclusionI conclude that it is necessary to take the influence of values (more) into account and include this knowledge into the training of physicians. Conclusively, recommendations for patients and physicians and their dealing with values in shared decision making processes are suggested.

Highlights

Decision making is omnipresent in medicine, and countless completely different matters have to be decided every day
If the cancer recurred, what should others know about their treatment goals? The study supplied evidence for five health-related values: self-sufficiency, life enjoyment, connectedness and legacy, balancing quality and length of life, and engagement in care (Naik et al 2016). These results show that patients have individual values, which they will voice when asked about them
While the importance of patients’ values in Shared Decision Making (SDM) is clearly articulated (Légaré und Witteman 2013), the influence of physicians’ values was hardly addressed in this context, which is shown by the few studies that dealt with physicians’ values (Hermann et al 2015; van Kleffens et al 2004; Sanders et al 2017)

Summary

Introduction

Decision making is omnipresent in medicine, and countless completely different matters have to be decided every day. In the SDM model and in recommendations on how to implement it in the medical practice, only the patient’s values receive attention and should be elicited during the decision making process (Elwyn et al 2012; Légaré and Witteman 2013). The physicians’ values already influenced the options that the physician is going to present to the patient This means that the patient does not get all viable options to choose from, which clearly constitutes a violation of the patient’s right to an autonomous decision (Beauchamp and Childress 2009) and should be avoided. In order to demonstrate how these new insights can be implemented into the training of physicians, I present a concept for a teaching unit that could be part of an ethics class

General Introduction to Values

Reflection of Personal Values

Values in Medical Decision Making

Conclusion

Compliance with ethical guidelines