Shared decision making in cases of conflicted evidence

An interesting article titled “When clinical evidence is conflicted, who decides how to proceed? An opportunity for shared decision making,” appears in the October 2015 issue of JADA (vol. 146 issue 10, pp. 713-714) and written by Arthur H. Friedlander and et al. The article discusses the concept of shared decision making “…particularly necessary in dentistry at this juncture, given recommendations but inconclusive data available to support abandoning the provision of prophylactic antibiotics to patients with total joint prostheses.” I have previously talked about shared medical decision making in the blog post The Well Informed Patient http://blog.teethremoval.com/the-well-informed-patient/.

The article talks about how historically patients were expected to consent to the recommendations of their doctors without much discussion. However, since this is not enough to be legally and ethically correct shared decision making can be used which is a “…collaborative process encouraging patients and their providers to make health care decisions together, taking into account the best scientific evidence available as well as the patient’s values and preferences.”

The authors go on to state

“This bioethical, patient-centered, informed consent process demonstrates respect for the patient’s autonomy and supports their empowerment at a time when illness renders them dependent and vulnerable. Furthermore, it enhances the patient’s knowledge of their medical condition, fosters shared acceptance of uncertainty, reduces decisional conflict, and improves clinical outcomes by promoting treatment adherence.”

The article talks about how these concepts were mentioned at a dental conference discussing discontinuing prescribing antibiotics for patients with prosthetic joints. At the conference it was mentioned that in such a case the clinician and patient together consider the circumstances that might pose a medical risk.

The article mentions that dentists can do a better job to communicate health information to their patients. For example patient decision aids can be used to help teach patients. The author suggest that the American Dental Association holds a meeting with various dental groups to “…develop educational interventions that will help practicing dentists, faculty responsible for educating dental students, and residents meet the precepts of [shared decision making].”

As I have discussed before on this blog I am not a big fan of the traditional informed consent process. Therefore, I welcome these efforts to move towards more shared decision making in dentistry.

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