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April 4, 2017

Prime Time for Shared Decision Making

Author Affiliations
  • 1Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
  • 2Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Connecticut
  • 3Informed Medical Decisions Foundation, Healthwise Research and Advocacy, Boston, Massachusetts
JAMA. 2017;317(13):1309-1310. doi:10.1001/jama.2017.0616

The recognition that informed patients often choose more conservative and hence less expensive medical options has made shared decision making a focus of value-based care.1 In 2007, Washington State passed legislation incentivizing shared decision making as an alternative to traditional informed consent procedures and forms for preference-based treatment decisions that include an elective procedure, such as joint replacement for hip or knee osteoarthritis.2 To qualify as this alternative to traditional informed consent, clinicians are required to use a certified decision aid to facilitate discussion about the different treatment options and patients need to sign an attestation that they reviewed the decision aid with the clinician, discussed the alternatives, risks, and benefits, and decided on a specific course of action. Clinicians who practice shared decision making will be presumed to have engaged patients in an informed consent process regarding the elective procedure and will be provided with increased protection against potential ensuing litigation based on failure to inform. Specifically, the use of the tools and the process associated with this use would shift the burden in litigation to patients to demonstrate clear and convincing evidence that they were not informed.2 In 2016, Washington State certified the first decision aids in maternal-fetal care related to decisions for birth options after cesarean delivery, for amniocentesis, and for genetic screening.

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