Evidence map›Paper›PMID 30144968›Full record

ArticlePatient education and counseling2018

Keeping the patient in the center: Common challenges in the practice of shared decision making.

Kimberly A Fisher, Andy S L Tan, Daniel D Matlock, Barry Saver, Kathleen M Mazor, Arwen H Pieterse

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Patient education and counseling, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers.

0numbers the graph read from it
0cells of the map it votes in
39citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

39 citing papers in PubMed.

  1. Trial
  2. Trial
  3. Potential Adverse Outcomes of Shared Decision Making about Palliative Cancer Treatment: A Secondary Analysis of a Randomized Trial.Medical decision making : an international journal of the Society for Medical Decision Making · 2024
    Trial
  4. Article
  5. Article
  6. Article
  7. Moral diversity and the challenge of responsibility in AI-CDSS.Philosophy, ethics, and humanities in medicine : PEHM · 2026
    Article
  8. Article
  9. Article
  10. Article
  11. Article
  12. Article
  13. Article
  14. Article
  15. Cancer Patients' Experiences of Burden when Involved in Treatment Decision Making.Medical decision making : an international journal of the Society for Medical Decision Making · 2025
    Article
  16. Article
  17. Article
  18. Review
  19. Advances in the Insulin-Heart Axis: Current Therapies and Future Directions.International journal of molecular sciences · 2024
    Review
  20. Comorbid Dementia and Cancer Therapy Decision-Making: A Scoping Review.Journal of applied gerontology : the official journal of the Southern Gerontological Society · 2024
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Kimberly A FisherDepartment of Medicine, University of Massachusetts Medical School, Worcester, MA, USA; Meyers Primary Care Institute, A joint Endeavor Between the University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, MA, USA. Electronic address: Kimberly.Fisher@umassmemorial.org.
Andy S L TanDivision of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Daniel D MatlockDivision of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA; VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO, USA.
Barry SaverSwedish Family Medicine Residency Cherry Hill, Seattle, WA, USA; Department of Family and Community Medicine, University of Massachusetts, Worcester, MA, USA.
Kathleen M MazorDepartment of Medicine, University of Massachusetts Medical School, Worcester, MA, USA; Meyers Primary Care Institute, A joint Endeavor Between the University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, MA, USA.
Arwen H PieterseDepartment of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands.

Funding

Patient-Perceived Breakdowns in Care: Informing Physician Responses and Improvements in Healthcare DeliveryK08HS024596 · AHRQ · UNIV OF MASSACHUSETTS MED SCH WORCESTER · PI FISHER, KIMBERLY · 2016 to 2020
$738k
AHRQ HHS K08 HS024596
6 · The paper itself

Abstract

objectiveTo examine situations where shared decision making (SDM) in practice does not achieve the goal of a patient-centered decision.

methodsWe explore circumstances in which elements necessary to realize SDM - patient readiness to participate and understanding of the decision - are not present. We consider the influence of contextual factors on decision making.

resultsPatients' preference and readiness for participation in SDM are influenced by multiple interacting factors including the patient's comprehension of the decision, their emotional state, the strength of their relationship with the clinician, and the nature of the decision. Uncertainty often inherent in information can lead to misconceptions and ill-formed opinions that impair patients' understanding. In combination with cognitive biases, these factors may result in decisions that are incongruent with patients' preferences. The impact of suboptimal understanding on decision making may be augmented by the context.

conclusionsThere are circumstances in which basic elements required for SDM are not present and therefore the clinician may not achieve the goal of a patient-centered decision. PRACTICE IMPLICATIONS: A flexible and tailored approach that draws on the full continuum of decision making models and communication strategies is required to achieve the goal of a patient-centered decision.

Indexed as

CommunicationComprehensionDecision MakingPatient-Centered CarePatient ParticipationCultureDelivery of Health CareFemaleHumansMalePatient PreferencePhysician-Patient RelationsUncertaintyDecisional agencyHealthcare settingPatient engagementShared decision making

Identifiers

PMID30144968
PMCPMC6376968

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.