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Review
. 2013 Nov;2(6):595-603.
doi: 10.2217/cer.13.69.

Shared decision-making and comparative effectiveness research for patients with chronic conditions: an urgent synergy for better health

Michael R Gionfriddo  1 , Aaron L Leppin, Juan P Brito, Annie Leblanc, Nilay D Shah, Victor M Montori
Affiliations
Review

Shared decision-making and comparative effectiveness research for patients with chronic conditions: an urgent synergy for better health

Michael R Gionfriddo et al. J Comp Eff Res. 2013 Nov.

Abstract

Chronic conditions are the most important cause of morbidity, mortality and health expense in the USA. Comparative effectiveness research (CER) seeks to provide evidence supporting the relative value of alternative courses of action. This research often concludes with estimates of the likelihood of desirable and undesirable outcomes associated with each option. Patients with chronic conditions should engage with their clinicians in deciding which of these options best fits their goals and context. In practicing shared decision-making (SDM), clinicians and patients should make use of CER to inform their deliberations. In these ways, SDM and CER are interrelated. SDM translates CER into patient-centered practice, while CER provides the backbone evidence about options and outcomes in SDM interventions. In this review, we explore the potential for a SDM-CER synergy in improving healthcare for patients with chronic conditions.

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Conflict of interest statement

Financial & competing interests disclosure

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Figures

Figure 1
Figure 1
Model of shared decision-making in chronic conditions.
See this image and copyright information in PMC

References

    1. Institue of Medicine. Initial National Priorities for Comparative Effectiveness Research. Washington, DC, USA: National Academies Press; 2009.

    1. Legare F, Witteman HO. Shared decision making: examining key elements and barriers to adoption into routine clinical practice. Health Aff. (Millwood) 2013;32(2):276–284. ▪ Provides an analysis of key elements of shared decision-making (SDM) and examines the barriers to its implementation into practice.

    1. Bodenheimer T, Chen E, Bennett HD. Confronting the growing burden of chronic disease: can the U.S. health care workforce do the job? Health Aff. (Millwood) 2009;28(1):64–74. - PubMed

    1. Making Health Care Decisions: A Report on the Ethical and Legal Implications of Informed Consent in the Patient–Practitioner Relationship. Washington, DC, USA: US Government Printing Office; 1982. President’s Commission for the Study of Ethical Problems in Medicine and Behavioral Research. ▪ Report by the Presidential Commission that called for SDM and stated that it was the “appropriate ideal for patient–professional relationships”.

    1. Szasz TS, Hollender MH. A contribution to the philosophy of medicine; the basic models of the doctor-patient relationship. AMA Arch. Intern. Med. 1956;97(5):585–592. ▪ Early report on the different modes of patient–physician interaction. The authors suggest that the model of mutual particpation (a philosophical precursor to SDM) would be most appropriate in the treatment of chronic conditions.

Websites

    1. CDC. Chronic Disease and Health Promotion. 2012 www.cdc.gov/chronicdisease/overview/index.htm.
    1. IPDAS Collaboration. The 2012 IPDAS Background Document. 2012 http://ipdas.ohri.ca/resources.html.
    1. 7th International Shared Decision-Making Conference; www.isdm2013.org.

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