<i>Annals</i> Clinical Decision Making: Communicating Risk and Engaging Patients in Shared Decision Making
Katrina Armstrong, Joshua P. Metlay
Abstract
Special Articles19 May 2020Annals Clinical Decision Making: Communicating Risk and Engaging Patients in Shared Decision MakingKatrina A. Armstrong, MD, MS and Joshua P. Metlay, MD, PhDKatrina A. Armstrong, MD, MSMassachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (K.A.A., J.P.M.) and Joshua P. Metlay, MD, PhDMassachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (K.A.A., J.P.M.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-3495 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Making good clinical decisions involves understanding evidence, thoughtful application of diagnostic testing, navigating heuristics and biases, and translating population-based evidence to an individual patient. In the end, however, there is often no perfect choice. Most decisions involve meaningful tradeoffs. Nearly all decisions involve significant uncertainty. This reality drives the modern emphasis on involving patients in the decision-making process—a paradigm referred to as "shared decision making." Few argue with the principle that patients should be informed participants in their clinical decisions. Yet, this principle is hard to implement effectively in clinical practice because of challenges inherent to risk communication, preference assessment, ...References1. Metlay JP, Armstrong KA. Annals clinical decision making: Weighing evidence to inform clinicaldecisions. Ann Intern Med. 21 April 2020. [Epub ahead of print]. doi:10.7326/M19-1941 LinkGoogle Scholar2. Armstrong KA, Metlay JP. Annals clinical decision making: Translating population evidence to individual patients. Ann Intern Med. 21 April 2020. [Epub ahead of print]. doi:10.7326/M19-3496 LinkGoogle Scholar3. Whitney SN, McGuire AL, McCullough LB. A typology of shared decision making, informed consent, and simple consent. Ann Intern Med. 2004;140:54-9. [PMID: 14706973] LinkGoogle Scholar4. Meijers-Heijboer H, van Geel B, van Putten WL, et al. Breast cancer after prophylactic bilateral mastectomy in women with a BRCA1 or BRCA2 mutation. N Engl J Med. 2001;345:159-64. [PMID: 11463009] CrossrefMedlineGoogle Scholar5. Nelson HD, Fu R, Zakher B, et al. Medication use for the risk reduction of primary breast cancer in women: updated evidence report and systematic review for the US preventive services task force. JAMA. 2019;322:868-886. [PMID: 31479143] doi:10.1001/jama.2019.5780 CrossrefMedlineGoogle Scholar6. Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for the prevention of breast cancer: current status of the National Surgical Adjuvant Breast and Bowel Project P-1 study. J Natl Cancer Inst. 2005;97:1652-62. [PMID: 16288118] CrossrefMedlineGoogle Scholar7. Tischler J, Crew KD, Chung WK. Cases in precision medicine: the role of tumor and germline genetic testing in breast cancer management. Ann Intern Med. 2019. [PMID: 31634909]. doi:10.7326/M18-2417 LinkGoogle Scholar8. National Cancer Institute. Breast Cancer Risk Assessment Tool. Accessed at https://bcrisktool.cancer.gov/ on 9 March 2020. Google Scholar9. American Cancer Society. Summary of the ACS Guidelines on Nutrition and Physical Activity. Accessed at www.cancer.org/healthy/eat-healthy-get-active/acs-guidelines-nutrition-physical-activity-cancer-prevention/summary.html on 9 March 2020. Google Scholar10. Restrepo D, Armstrong KA, Metlay JP. Annals clinical decision making: avoiding cognitive errors in clinical decision making. Ann Intern Med. 21 April 2020. [Epub ahead of print]. doi:10.7326/M19-3692 LinkGoogle Scholar11. Lipkus IM, Peters E. Understanding the role of numeracy in health: proposed theoretical framework and practical insights. Health Educ Behav. 2009;36:1065-81. [PMID: 19834054] doi:10.1177/1090198109341533 CrossrefMedlineGoogle Scholar12. Lipkus IM, Samsa G, Rimer BK. General performance on a numeracy scale among highly educated samples. Med Decis Making. 2001 Jan-Feb;21:37-44. [PMID: 11206945] CrossrefMedlineGoogle Scholar13. Armstrong KA, Metlay JP. Annals clinical decision making: Using a diagnostic test. Ann Intern Med. 21 April 2020. [Epub ahead of print]. doi:10.7326/M19-1940 LinkGoogle Scholar14. Zipkin DA, Umscheid CA, Keating NL, et al. Evidence-based risk communication: a systematic review. Ann Intern Med. 2014;161:270-80. [PMID: 25133362]. doi:10.7326/M14-0295 LinkGoogle Scholar15. Gail MH, Costantino JP, Bryant J, et al. Weighing the risks and benefits of tamoxifen treatment for preventing breast cancer. J Natl Cancer Inst. 1999;91:1829-46. [PMID: 10547390] CrossrefMedlineGoogle Scholar16. Fagerlin A, Zikmund-Fisher BJ, Ubel PA. Helping patients decide: ten steps to better risk communication. J Natl Cancer Inst. 2011;103:1436-43. [PMID: 21931068] doi:10.1093/jnci/djr318 CrossrefMedlineGoogle Scholar17. Stacey D, Légaré F, Col NF, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2014:CD001431. [PMID: 24470076] doi:10.1002/14651858.CD001431.pub4 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (K.A.A., J.P.M.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-3495.Corresponding Author: Katrina A. Armstrong, MD, Massachusetts General Hospital, Gray-Bigelow 7, 55 Fruit Street, Boston, MA 02114; e-mail, [email protected]harvard.edu.Current Author Addresses: Dr. Armstrong: Massachusetts General Hospital, Gray-Bigelow 7, 55 Fruit Street, Boston, MA 02114.Dr. Metlay: Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge Street, 16th Floor, Boston, MA 02114.Author Contributions: Conception and design: K.A. Armstrong, J.P. Metlay.Drafting of the article: K.A Armstrong, J.P. Metlay.Critical revision for important intellectual content K.A. Armstrong.Final approval of the article: K.A. Armstrong, J.P. Metlay.Administrative, technical, or logistic support: K.A. Armstrong.This article was published at Annals.org on 21 April 2020. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoClinical Decision Making: Nurturing Our Core Skills Darren B. Taichman , Sankey V. Williams , and Christine Laine Annals Clinical Decision Making: Weighing Evidence to Inform Clinical Decisions Joshua P. Metlay and Katrina A. Armstrong Annals Clinical Decision Making: Translating Population Evidence to Individual Patients Katrina A. Armstrong and Joshua P. Metlay Clinical Decision Making: Nurturing Our Core Skills Darren B. Taichman , Sankey V. Williams , and Christine Laine Annals Clinical Decision Making: Avoiding Cognitive Errors in Clinical Decision Making Daniel Restrepo , Katrina A. Armstrong , and Joshua P. Metlay Metrics Cited byRe: Mathew D. Sorensen, Jonathan D. Harper, Michael S. Borofsky, et al. Removal of Small, Asymptomatic Kidney Stones and Incidence of Relapse. N Engl J Med 2022;387:506–13An exploration of expectations and perceptions of practicing physicians on the implementation of computerized clinical decision support systems using a Qsort approachVitruvian plot: a visualisation tool for multiple outcomes in network meta-analysisCan Machine Learning from Real-World Data Support Drug Treatment Decisions? A Prediction Modeling Case for Direct Oral AnticoagulantsCost: An Important Question That Must Be AskedAdverse health effects after breast cancer up to 14 years after diagnosisThe Serious Factor in Expanded Prenatal Genetic TestingInnovations in Integrating Smoking Cessation and the Shared Decision-Making Discussion into Lung Cancer ScreeningImproving acute pain management of trauma patients on medication-assisted therapyA Veteran-Centric Web-Based Decision Aid for Lung Cancer Screening: Usability AnalysisBlood and Marrow Transplant Clinical Trials Network Study 1102 heralds a new era in hematopoietic cell transplantation in high‐risk myelodysplastic syndromes: Challenges and opportunities in implementationEffectiveness of decision aids on cancer-screening decision-making: an umbrella review protocolA Systematic Review of Shared Decision–Making Interventions for Service Users With Serious Mental Illnesses: State of the Science and Future DirectionsCOVID-19 and the future of clinical epidemiologyClinician Conceptualization of the Benefits of Treatments for Individual PatientsSupporting Communication of Shared Decision-Making Principles in US Preventive Services Task Force RecommendationsAccuracy of Practitioner Estimates of Probability of Diagnosis Before and After TestingShared Decision MakingProblems with Numbers in Decision Aids for Prostate-specific Antigen Screening: A Critical ReviewComprehensive Geriatric AssessmentComprehensive Geriatric AssessmentComprehensive Geriatric AssessmentAnticoagulation and bleeding risk in patients with COVID-19Use of Shared Decision‐Making in Response to Maternal Request for Elective Cesarean BirthAnnals Clinical Decision Making: Using a Diagnostic TestKatrina A. Armstrong, MD, MS and Joshua P. Metlay, MD, PhDAnnals Clinical Decision Making: Translating Population Evidence to Individual PatientsKatrina A. Armstrong, MD, MS and Joshua P. Metlay, MD, PhDClinical Decision Making: Nurturing Our Core SkillsDarren B. Taichman, MD, PhD, Executive Editor, Sankey V. Williams, MD, Deputy Editor, and Christine Laine, MD, MPH, Editor in Chief Using the Causal Inference Framework to Support Individualized Drug Treatment Decisions Based on Observational Healthcare Data 19 May 2020Volume 172, Issue 10Page: 688-692KeywordsAlcoholsBreast cancerCancer risk factorsDecision makingExerciseHospital medicineHysterectomyRelative riskSurgeryThromboembolism ePublished: 21 April 2020 Issue Published: 19 May 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...