Download PDF
Psychother Psychosom Med Psychol 2016; 66(05): 195-207
DOI: 10.1055/s-0042-105277
Fort- und Weiterbildung
© Georg Thieme Verlag KG Stuttgart · New York

Partizipative Entscheidungsfindung (PEF) – Patient und Arzt als Team

Shared Decision Making (SDM) – Patient and Physician as a Team
Christiane Bieber
Klinik für Allgemeine Innere Medizin und Psychosomatik, Zentrum für Psychosoziale Medizin, Universitätsklinikum Heidelberg
,
Kathrin Gschwendtner
Klinik für Allgemeine Innere Medizin und Psychosomatik, Zentrum für Psychosoziale Medizin, Universitätsklinikum Heidelberg
,
Nicole Müller
Klinik für Allgemeine Innere Medizin und Psychosomatik, Zentrum für Psychosoziale Medizin, Universitätsklinikum Heidelberg
,
Wolfgang Eich
Klinik für Allgemeine Innere Medizin und Psychosomatik, Zentrum für Psychosoziale Medizin, Universitätsklinikum Heidelberg
› Author Affiliations
Further Information

Publication History

Publication Date:
27 April 2016 (online)

Also available at
   Permissions and Reprints

Zusammenfassung

Der Artikel gibt einen Überblick über das Konzept der Partizipativen Entscheidungsfindung (PEF), das von vielen Akteuren des Gesundheitssystems als besonders günstige Form der Arzt-Patient-Interaktion verstanden wird. Die PEF wird abgegrenzt gegen weitere Modelle der Arzt-Patient-Interaktion wie das Paternalistische Modell und das Informationsmodell. Neben den Akzeptanzwerten von PEF in der Bevölkerung und unter Ärzten wird auch auf mögliche Barrieren in der Umsetzung eingegangen. Anwendungsbereiche für die PEF werden besprochen und Strategien sowie Hilfsmaterialien zur Umsetzung im individuellen Arzt-Patient-Kontakt dargestellt und anhand eines onkologischen Fallbeispiels vertieft. Effekte der PEF für Patienten und für Behandler werden aufgezeigt. Nach Eingehen auf wichtige Quellen von PEF erfolgt die Einordnung vor dem aktuellen gesundheitspolitischen Hintergrund in Deutschland.

Abstract

The article provides an overview on Shared Decision Making (SDM), which is considered as the ideal form of physician-patient-interaction by many stakeholders of the health care system. SDM is distinguished from other models of physician-patient-interaction such as the paternalistic model and the information model. Besides the degree of acceptance of SDM in the general population and among physicians, barriers for its implementation will be reported. Indications for SDM as well as strategies and support material for its use in individual consultations will be discussed and illustrated by an oncological case study. Effects of SDM for patients as well as for clinicians will be highlighted. After background information on origins of SDM, its significance with regard to health policy in Germany is discussed.

Schlüsselwörter

Partizipative Entscheidungsfindung (PEF) - Arzt-Patient-Interaktion - Medizinische Entscheidungshilfe - Patientenzentrierung

Keywords

Shared Decision Making (SDM) - physician-patient-interaction - Patient Decision Aid (PtDA) - patient-centeredness
 

  • Literatur

  • 1 Härter M. Shared decision making – from the point of view of patients, physicians and health politics is set in place. Z Arztl Fortbild Qualitatssich 2004; 98: 89-92
    PubMedSearch in Google Scholar
  • 2 Bundesministerium für Gesundheit. Patientenrechte in Deutschland. Leitfaden für Patientinnen/Patienten und Ärztinnen/Ärzte. 5. Aufl. Berlin: 2007
    Search in Google Scholar
  • 3 Elwyn G, Frosch D, Thomson R et al. Shared decision making: a model for clinical practice. J Gen Intern Med 2012; 27: 1361-1367
    CrossrefPubMedSearch in Google Scholar
  • 4 Charles C, Gafni A, Whelan T. Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model. Soc Sci Med 1999; 49: 651-661
    CrossrefPubMedSearch in Google Scholar
  • 5 Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med 1997; 44: 681-692
    CrossrefPubMedSearch in Google Scholar
  • 6 Towle A, Godolphin W. Framework for teaching and learning informed shared decision making. BMJ 1999; 319: 766-771
    CrossrefPubMedSearch in Google Scholar
  • 7 Elwyn G, Edwards A, Kinnersley P. Shared decision-making in primary care: the neglected second half of the consultation. Br J Gen Pract 1999; 49: 477-482
    PubMedSearch in Google Scholar
  • 8 Ernst J, Schwarz R, Krauß O. Shared decision making bei Tumorpatienten. Ergebnisse einer empirischen Studie. J Public Health 2004; 12: 123-131
    CrossrefPubMedSearch in Google Scholar
  • 9 Charles C, Whelan T, Gafni A. What do we mean by partnership in making decisions about treatment?. BMJ 1999; 319: 780-782
    CrossrefPubMedSearch in Google Scholar
  • 10 Böcken J, Braun B, Schnee M Hrsg. Gesundheitsmonitor 2004. Die ambulante Versorgung aus Sicht von Bevölkerung und Ärzteschaft. 1. Aufl. Gütersloh: Verlag Bertelsmann Stiftung; 2004
    Search in Google Scholar
  • 11 Böcken J, Braun B, Meierjürgen R Hrsg. Gesundheitsmonitor 2014, Bürgerorientierung im Gesundheitswesen. 1. Aufl. Gütersloh: Bertelsmann Stiftung, Barmer GEK; 2014
    Search in Google Scholar
  • 12 Coulter A, Magee H. The European Patient of the Future – State of Health. Maidenhead: Open University Press, McGraw Hill Companies; 2003
    Search in Google Scholar
  • 13 Klemperer D, Rosenwirt M. Shared Decision Making: Konzept, Voraussetzungen und politische Implikationen. Chartbook. Gütersloh: Bertelsmann Stiftung, Universität Bremen; 2005
    Search in Google Scholar
  • 14 Floer B, Schnee M, Bocken J et al. Shared decision making. The perspective of practicing physicians. Med Klin (Munich) 2004; 99: 435-440
    CrossrefPubMedSearch in Google Scholar
  • 15 Legare F, Ratte S, Gravel K et al. Barriers and facilitators to implementing shared decision-making in clinical practice: update of a systematic review of health professionals’ perceptions. Patient Educ Couns 2008; 73: 526-535
    CrossrefPubMedSearch in Google Scholar
  • 16 Legare F, Thompson-Leduc P. Twelve myths about shared decision making. Patient Educ Couns 2014; 96: 281-286
    CrossrefPubMedSearch in Google Scholar
  • 17 Joseph-Williams N, Elwyn G, Edwards A. Knowledge is not power for patients: A systematic review and thematic synthesis of patient-reported barriers and facilitators to shared decision making. Patient Educ couns 2014; 94: 291-309
    CrossrefPubMedSearch in Google Scholar
  • 18 Elwyn G, Edwards A, Kinnersley P et al. Shared decision making and the concept of equipoise: the competences of involving patients in healthcare choices. Br J Gen Pract 2000; 50: 892-899
    PubMedSearch in Google Scholar
  • 19 Whitney SN. A new model of medical decisions: exploring the limits of shared decision making. Med Decis Making 2003; 23: 275-280
    CrossrefPubMedSearch in Google Scholar
  • 20 Kiesler DJ, Auerbach SM. Optimal matches of patient preferences for information, decision-making and interpersonal behavior: evidence, models and interventions. Patient Educ Couns 2006; 61: 319-341
    CrossrefPubMedSearch in Google Scholar
  • 21 Elwyn G, Tsulukidze M, Edwards A et al. Using a ‘talk’ model of shared decision making to propose an observation-based measure: Observer OPTION 5 Item. Patient Educ Couns 2013; 93: 265-271
    CrossrefPubMedSearch in Google Scholar
  • 22 Loh A, Simon D, Rockenbauch K et al. Shared Decision Making – importance and dissemination in medical education. Z Med Psychol 2006; 15: 87-92
    PubMedSearch in Google Scholar
  • 23 Bieber C, Nicolai J, Hartmann M et al. Training physicians in shared decision-making – who can be reached and what is achieved?. Patient Educ Couns 2009; 77: 48-54
    CrossrefPubMedSearch in Google Scholar
  • 24 Bieber CLA, Ringel N, Eich W, Härter M. Patientenbeteiligung bei medizinischen Entscheidungen: Manual zur Partizipativen Entscheidungsfindung (Shared Decision Making). Heidelberg: Universitätsklinikum Heidelberg; 2007
    Search in Google Scholar
  • 25 Elwyn G, Edwards A, Hood K et al. Achieving involvement: process outcomes from a cluster randomized trial of shared decision making skill development and use of risk communication aids in general practice. Fam Pract 2004; 21: 337-346
    CrossrefPubMedSearch in Google Scholar
  • 26 Härter M, Buchholz A, Nicolai J et al. Shared Decision Making and the Use of Decision Aids. Dtsch Arztebl Int 2015; 112: 672-679
    PubMedSearch in Google Scholar
  • 27 Gurm HS, Litaker DG. Framing procedural risks to patients: is 99% safe the same as a risk of 1 in 100?. Acad Med 2000; 75: 840-842
    CrossrefPubMedSearch in Google Scholar
  • 28 Hamann J, Mendel R, Meier A et al. "How to speak to your psychiatrist": shared decision-making training for inpatients with schizophrenia. Psychiatr Serv 2011; 62: 1218-1221
    CrossrefPubMedSearch in Google Scholar
  • 29 Stacey D, Bennett CL, Barry MJ et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2011; CD001431
    PubMedSearch in Google Scholar
  • 30 Elwyn G, O’Connor A, Stacey D et al. Developing a quality criteria framework for patient decision aids: online international Delphi consensus process. BMJ 2006; 333: 417
    CrossrefPubMedSearch in Google Scholar
  • 31 Caspari C, Vodermaier A. Entscheidungshilfe für Frauen mit Brustkrebs: Brusterhaltende Therapie oder Brustentfernung? Gemeinsame Planung der Operation bei kleinem Tumor. Berlin: AOK Bundesverband; 2008
    Search in Google Scholar
  • 32 Loh A, Simon D, Kriston L et al. Patientenbeteiligung bei medizinischen Entscheidungen. Effekte der Partizipativen Entscheidungsfindung aus systematischen Reviews. Dtsch Arztebl 2007; 104: A1483-A1488
    PubMedSearch in Google Scholar
  • 33 Stacey D, Legare F, Col NF et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2014; 1 CD001431
    PubMedSearch in Google Scholar
  • 34 Bieber C, Nicolai J. Behandlung nach der Operation beim Dickdarmkrebs (Kolonkarzinom) im Stadium II: Unterstützende (adjuvante) Chemotherapie – Ja oder Nein? Entscheidungshilfe zur Gemeinsamen Planung der weiteren Behandlungsschritte. 1. Aufl. Heidelberg: Universitätsklinikum Heidelberg; 2010
    Search in Google Scholar
  • 35 Wennberg JE. Unwarranted variations in healthcare delivery: implications for academic medical centres. BMJ 2002; 325: 961-964
    CrossrefPubMedSearch in Google Scholar
  • 36 Hochlehnert A, Richter A, Bludau HB et al. A computer-based information-tool for chronic pain patients. Computerized information to support the process of shared decision-making. Patient Educ Couns 2006; 61: 92-98
    CrossrefPubMedSearch in Google Scholar
  • 37 Bieber C, Muller KG, Blumenstiel K et al. Long-term effects of a shared decision-making intervention on physician-patient interaction and outcome in fibromyalgia. A qualitative and quantitative 1 year follow-up of a randomized controlled trial. Patient Educ Couns 2006; 63: 357-366
    CrossrefPubMedSearch in Google Scholar
  • 38 Loh A, Simon D, Wills CE et al. The effects of a shared decision-making intervention in primary care of depression: a cluster-randomized controlled trial. Patient Educ Couns 2007; 67: 324-332
    CrossrefPubMedSearch in Google Scholar
  • 39 Loh A, Leonhart R, Wills CE et al. The impact of patient participation on adherence and clinical outcome in primary care of depression. Patient Educ Couns 2007; 65: 69-78
    CrossrefPubMedSearch in Google Scholar
  • 40 Vodermaier A, Caspari C, Koehm J et al. Contextual factors in shared decision making: a randomised controlled trial in women with a strong suspicion of breast cancer. Br J Cancer 2009; 100: 590-597
    CrossrefPubMedSearch in Google Scholar
  • 41 Vodermaier A, Caspari C, Wang L et al. How and for whom are decision aids effective? Long-term psychological outcome of a randomized controlled trial in women with newly diagnosed breast cancer. Health Psychol 2011; 30: 12-19
    CrossrefPubMedSearch in Google Scholar
  • 42 Hamann J, Cohen R, Leucht S et al. Do patients with schizophrenia wish to be involved in decisions about their medical treatment?. Am J Psychiatry 2005; 162: 2382-2384
    CrossrefPubMedSearch in Google Scholar
  • 43 Hamann J, Cohen R, Leucht S et al. Shared decision making and long-term outcome in schizophrenia treatment. J Clin Psychiatry 2007; 68: 992-997
    CrossrefPubMedSearch in Google Scholar
  • 44 Hamann J, Langer B, Winkler V et al. Shared decision making for in-patients with schizophrenia. Acta Psychiatr Scand 2006; 114: 265-273
    CrossrefPubMedSearch in Google Scholar
  • 45 Härter M, Muller H, Dirmaier J et al. Patient participation and shared decision making in Germany – history, agents and current transfer to practice. Z Evid Fortbild Qual Gesundhwes 2011; 105: 263-270
    CrossrefPubMedSearch in Google Scholar
  • 46 Loh A, Simon D, Rockenbauch K et al. Partizipative Entscheidungsfindung – Stellenwert und Verbreitung in der medizinischen Ausbildung. Z Med Psychol 2006; 15: 87-92
    PubMedSearch in Google Scholar