Shared Decision Making

Stroke occurs suddenly, and so patients and families are often unprepared for making treatment decisions. For most people, a stroke is a shock. With no prior experience of dealing with stroke they are not only unprepared; also they just don’t know what options they have nor do they have a benchmark for supporting them to make the best decisions for themselves or their loved ones. Furthermore, aphasia, cognitive impairment or impaired consciousness mean that patients cannot express their own views. So, active treatment is often given to ‘see how things go’, but this can prolong dying, cause discomfort and harm, and lead to unwelcome survival with severe disability and lifelong institutional care, which might be inconsistent with the patient’s prior wishes.

Shared decision making (SDM) can be defined as an interpersonal, interdependent process in which health professionals, patients and their caregivers relate to and influence each other as they Collaborate in making decisions about a patient’s health. Policy makers perceive SDM as desirable because:

a) patient involvement is accepted as a right

b) patients in general want more information about their health condition and prefer to take an active role in decisions about their health

c) SDM may reduce the overuse of options not clearly associated with benefits for all and increase the use of options clearly associated with benefits for the vast majority of the concerned population

(d) SDM may reduce unwarranted healthcare practice variations

e) SDM may foster the sustainability of the healthcare system by increasing patient ownership of their own health care.