Abstract
Currently, shared decision making (SDM) is on the agenda among target patient representative
groups, policy makers and professional bodies. Although the International Conference
for Shared Decision Making (ISDM) 2011 generated a positive boost, hesitation was
also felt among Dutch clinicians, who are challenged by many new tasks. No hesitation
is seen among the majority of patients, opting mostly for the SDM model. We haven’t
reached these patients’ needs fully yet, given disappointing research data on patients’
experiences and professional behaviour.
There is plenty of room for improvement in daily practice, for which many best practices
are being designed and increasingly implemented, such as national campaigns to empower
patients, central governance of patient decision aids that are developed along clinical
practice guidelines, postgraduate training, collaborative learning and system changes,
and merging goal setting and SDM in complex care. This is explicitly supported by
the Dutch government, the Ministry of Health, patient groups, professional bodies
and health insurers. The culture shift in the minds and hearts of patients and clinicians
has started but is still ongoing. Enthusiasm for this way of working could be undermined
if SDM is defined and implemented in a simplistic, dogmatic manner leading to irresponsible
transferring of the professionals’ uncertainty, responsibility, and decisional stress
to patients.
Zusammenfassung
Das Thema partizipative Entscheidungsfindung im Gesundheitswesen steht aktuell auf
der Tagesordnung von Patientenverbänden, politischen Entscheidungsträgern und Berufsverbänden.
Auch wenn die International Conference for Shared Decision Making (ISDM) 2011 ausgesprochen positive Resonanz fand, so war unter den niederländischen
Ärzten, auf die jetzt viele neue Aufgaben zukommen, diesbezüglich doch auch eine gewisse
Zurückhaltung zu beobachten. Patienten haben grundsätzlich Interesse und befürworten
eine partizipative Entscheidungsfindung (PEF) zumeist. Doch wie die enttäuschenden
Forschungsergebnisse in Bezug auf die Erfahrungen von Patienten und das Verhalten
von medizinischem Fachpersonal belegen, werden wir den Bedürfnissen der Patienten
noch nicht vollkommen gerecht.
Es gibt noch viel Spielraum für Verbesserungen, auch wenn schon viele exzellente Modellinterventionen
entwickelt und bereits in die tägliche Praxis implementiert worden sind. Beispiele
dafür sind nationale Initiativen zum Empowerment von Patienten, die zentrale Steuerung
von Entscheidungshilfen für Patienten, die zusammen mit klinischen Leitlinien entwickelt
wurden, Weiterbildungsangebote, gemeinschaftliches Lernen, die dafür erforderlichen
Systemveränderungen und die Zusammenführung von individuellen Gesundheitszielen und
partizipativer Entscheidungsfindung in komplexen Versorgungssituationen. Diese Initiativen
werden von verschiedenen politischen und sozialen Trägern unterstützt, u. a. von der
niederländischen Regierung, vom Gesundheitsministerium, von Patientenorganisationen
und -gruppen, Berufsverbänden sowie Krankenversicherern. Die Notwendigkeit einer Kulturveränderung
im niederländischen Gesundheitswesen hat Eingang ins Bewusstsein und die Herzen von
Patienten und Fachpersonal gefunden, muss sich aber noch weiter entwickeln. Die Begeisterung
für ein solches Vorgehen könnte einen Dämpfer erhalten, wenn partizipative Entscheidungsfindung
vereinfacht und dogmatisch definiert und umgesetzt würde, was zur Folge hätte, dass
Unsicherheit, Verantwortung und Entscheidungslast auf Seiten des Fachpersonals in
unverantwortlicher Weise auf die Patienten übergingen.
Keywords
Schlüsselwörter
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Article info
Publication history
Published online: May 18, 2017
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© 2017 Published by Elsevier Inc.
