2023-2024, Block 1 GW4002MV. Patient Centered Care Delivery
THEME 2
Co-creating Care Delivery
In PCCD, shared decision-making (SDM) is generally advocated as the preferred form of medical
decision-making. SDM is supported with reference to patient autonomy, one of the pillars of medical
ethics, without abandoning the patient or giving up the possibility of influencing how the patient is
benefited. Therefore, SDM is presented as an attractive decision-making model, as opposed to the more
extreme models of paternalism and consumerism. It is, however, defined in numerous different ways.
An overview will be presented of the essentials of SDM and its attractiveness will be explained from
ethical, economical, epidemiological and clinical points of view. Since it is also put forward that the
model may be less suited for certain (groups of) patients in certain circumstances, an analysis will be
given of the conditions under which SDM can be applied successfully.
__________________________________________________________________________________________________________________
Targets for theme 2:
Students have an understanding of SDM;
Students can argue pros and cons of SDM compared to other medical decision-making models;
Students can explain the (limited) applicability of SDM;
Students can argue the difficulties of putting SDM into practice;
Students understand the current (international) patients' rights protection and its underlying principles.
Inhoud
Knowledge clip..................................................................................................................................................2
1. The importance of being actively involved in your healthcare..............................................................2
Lecture 2. Shared (Medical) Decision-Making (8 sept).....................................................................................3
What?...........................................................................................................................................................3
Why?.............................................................................................................................................................3
When?..........................................................................................................................................................4
Obstacles?.....................................................................................................................................................5
Requirements?..............................................................................................................................................6
S(M)DM in the Netherlands..........................................................................................................................6
Workgroup meeting (12 sept)...........................................................................................................................7
Homework assignment.................................................................................................................................7
Case study on SDM.....................................................................................................................................11
1
, 2023-2024, Block 1 GW4002MV. Patient Centered Care Delivery
Knowledge clip
Part A: Before you watch the lecture on SDM by Prof. dr. Martin Buijsen, please have a look at the following
videos on YouTube. This video explains SDM very well.
https://youtu.be/_e0RkVrqQII
1. The importance of being actively involved in your healthcare
This video shows a paternal patient-doctor relationship in which the doctor makes all the decisions and the
patient sees the doctor as ‘sacred’.
Shared decision-making: empowering patients to take a more active role in health care decisions with their
physicians. Key elements to enable SDM: the 3 D’s:
Discuss: the physician has to discuss all the important information and possible options with the
patient. The patient has to be honest about their situation and feelings.
( Check: the physician has to check with the patient if everything is clear. )
Debate: the physician and patient have to go in debate about the possible decisions.
Decide: by discussing and debating the patient and physician come to a mutual conclusion/decision.
SDM is where patients and physicians come together to share an indecisive process about a treatment for
that patient. In this the patient is also actively involved in the clinical encounter. They would share in the
discussion about symptoms, pros and cons, and they would share in the actual decision what will be the
treatment they will leave the room with.
SDM leads to better involvement of the patient in his/her own treatment. They are more likely to follow
advice, take their medicine, etc.
2
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