Shared decision making

There is no SDM in clinical practice in Brazil. The first steps have been taken towards research and tool development recently. Likewise, our society is starting to get involved with decision making in health care. This paper aims to offer an overview of the Brazilian health system history, its values, and its influence on SDM. The participative social control concept is introduced as a result of the movement against the dictatorship era. In addition, the influence of social changes on the Medical Ethical Code is delineated. SDM state of the art in Brazil is also discussed and the challenges to implement it on clinical practice are described. Regardless the challenges, it is possible to make a positive assessment of SDM in Brazil.

WHAT ABOUT POLICY REGARDING SDM? Since 1999, there has been a small but growing interest by academics, the government, and society as a whole in strengthening patients' and professionals' involvement in shared decision making (SDM). Two governmental policy documents that indicate support for SDM are (1) Health Reform in 2003 and (2) Sanitary Objectives 2011-2020, which includes a brief section on client participation and SDM. WHAT ABOUT TOOLS - DECISION SUPPORT FOR PATIENTS? Research by Chilean academics has highlighted the patients' desire to participate in health decisions and effective approaches for enhancing health professionals' skills in interprofessional SDM; however, little has been done to support this need and the work is centralised in only one academic institution. Decision support tools and coaching interventions are limited to patients considering decisions about managing type 2 diabetes. WHAT ABOUT PROFESSIONAL INTEREST AND IMPLEMENTATION? Althoug...

Objective: To develop and psychometrically test a brief patient-report instrument for measuring Shared Decision Making (SDM) in clinical encounters. Methods: We revised an existing instrument (Shared Decision Making Questionnaire; SDM-Q), including the generation of new items and changing the response format. A 9-item version (SDM-Q-9) was developed and tested in a German primary care sample of 2351 patients via face validity ratings, investigation of acceptance, as well as factor and reliability analysis. Findings were cross-validated in a randomly selected subsample. Results: The SDM-Q-9 showed face validity and high acceptance. Factor analysis revealed a clearly onedimensional nature of the underlying construct. Both item difficulties and discrimination indices proved to be appropriate. Internal consistency yielded a Cronbach's a of 0.938 in the test sample.

We explore optimal cost-sharing provisions for insurance contracts when individuals have observable, severe diseases with a discrete number of medically appropriate treatment options. Variation in preferences for alternative treatments is unobserved by the insurer and non-contractible. Interest in such situations is increasingly common, exemplified by disease Ž . carve-out programs and shared decision-making SDM tools. We demonstrate that optimal insurance charges a copay to patients choosing the high-cost treatment and provides consumers of the low-cost treatment a cash payment. A simulation of the effect of such a policy, based on prostate cancer, indicates a substantial reduction in moral hazard. q 2000 Elsevier Science B.V. All rights reserved. JEL classification: I11; D81

Shared decision-making and person centred care (PCC/SDM) are increasingly embraced framework conceptions on how to organise health care's interaction with patients. Although underlying ethical motivation may vary, PCC/SDM holds ideals of a greater adaption of health care to individual circumstances, and of recognising patients as collaborators in clinical decision-making. The PCC/SDM notion has migrated quickly across many areas where it is less clear how it applies, due to patients being in non-standard conditions with regard to personal capacities or care context, and detected to offer a number of peculiar ethical and practical challenges. But the migration has also reached areas with even less similarity to the original PCC/SDM landscape of somatic hospital care. In this presentation, we describe – based on comissioned and work in a Swedish context and ongoing research studies – three examples of this expansion and survey these for extra ethical complications: forensic care, social services and public health (outside of health care institutions). Each area offers peculiar extra ethical challenges for PCC/SDM, as they depart extensively from standard assumptions by, in various ways, embracing goals not built on the standard individualist assumptions of health care ethics. It is possible to implement adapted forms of PCC/SDM to these areas, but these cannot be assumed to serve ideals of emancipating, empowering or recognising individuals as persons. Rather, they have to be viewed though a lens of public goods aimed for in the respective areas. Clients and patients are entitled to be made aware of this fact, but regardless of this, the mentioned perspective-shift will pose particular challenges for health professionals. At the same time, PCC/SDM strategies may also open up for approaches to resolving these tensions and meet typical challenges that would otherwise have remained out of reach.

Nurses are increasingly being called upon to be the conveyers of important statistical information to patients. This trend is particularly evident in the domains of genetics and cancer screening. These new roles, however, demand new competencies, such as the ability to solve statistical problems, and the skill to communicate the answers effectively, as effective communication is an important ingredient in shared decision making. Genetic testing, perhaps more than other medical domains, relies heavily on the use of statistics. Being able to convey statistical information effectively is vital. In this paper, we illustrate the problems health care professionals have had in tackling and communicating statistical information. We introduce the natural frequencies method of solving Bayesian inference problems and review empirical evidence that shows the superiority of this format. Being able to transform probabilities into natural frequencies facilitates correct Bayesian inferences. It is argued that the conventional approach to educating nurses in Bayesian problem solving should be reconsidered and their statistical curriculum should be supplemented with instruction in using the natural frequency format.

Background: Complementary and Alternative Medicine (CAM) is widely used throughout the UK and the Western world. CAM is commonly used for children and the decision-making process to use CAM is affected by numerous factors. Most research on CAM use lacks a theoretical framework and is largely based on bivariate statistics. The aim of this review was to identify a conceptual model which could be used to explain the decision-making process in parental choice of CAM.

Shared Decision Making has become paradigmatic in health care. By shared decision-making is meant that both the process and outcome of decisions about treatment options are shared between patient and provider. In mental health care it has very much been associated with the patient's recovery process. In the over-arching mental health policy framework that the UK government uses, recovery has been defined as: "A deeply personal, unique process of changing one's attitudes, values, feelings, goals, skills and/or roles. It is a way of living a satisfying, hopeful and contributing life, even with limitations caused by the illness. Recovery involves the development of new meaning and purpose in one's life." It is the task of the professional to facilitate this process by empowering the patient: enlarging the scope of his autonomy and self-direction, giving a person as much regime over his own life as possible and sharing the responsibility for decisions about treatment options. However, a dilemma looms up here if and when the patient and the professional have a different opinion on decisions that, according to the professional, may have the risk to land the patient in trouble: exacerbation of symptoms, increasing social exclusion, etc., but which the patient nevertheless wants and which he defends as his good right as an autonomous person.  Positive risk-taking aims at involving the person taking on new challenges leading to personal growth and development. This is an aspect of recovery-oriented care. When service users are denied this positive risk-taking then recovery is frustrated [1-6]. There is, we can say, a dignity of risks: without risks no challenges. The dilemma here is been discussed in this article

Objectives To better understand the causes of racial disparities in health care, we reviewed and synthesized existing evidence related to disparities in the “equal access” Veterans Affairs (VA) health care system. Methods We systematically reviewed and synthesized evidence from studies comparing health care utilization and quality by race within the VA. Results Racial disparities in the VA exist across a wide range of clinical areas and service types. Disparities appear most prevalent for medication adherence and surgery and other invasive procedures, processes that are likely to be affected by the quantity and quality of patient–provider communication, shared decision making, and patient participation. Studies indicate a variety of likely root causes of disparities including: racial differences in patients’ medical knowledge and information sources, trust and skepticism, levels of participation in health care interactions and decisions, and social support and resources; clinician judgment/bias; the racial/cultural milieu of health care settings; and differences in the quality of care at facilities attended by different racial groups. Conclusions Existing evidence from the VA indicates several promising targets for interventions to reduce racial disparities in the quality of health care.

This research examined the full range of tasks and activities that design engineers perform, how their working time is distributed among these, and how these issues influence their satisfaction with their work. Seventy-eight design engineers each carried a personal digital assistant (PDA) for twenty working days. Once every hour, they entered data into their PDAs concerning their current work tasks and satisfaction levels, using a work sampling approach. Work tasks were explored from multiple perspectives, yielding highly extensive and detailed results. A key finding was that design engineers' work involves considerable technical engineering work (62.92% of time) and socially collaborative work (40.37% of time). The results were discussed in terms of their implications for academic theory and organizational practice.

Zusammenfassung Die partnerschaftliche Einbeziehung von Patienten in Diagnoseerstellung und Behandlungsentscheidungen gewinnt auch in Deutschland zunehmend an Bedeutung. Unter dem Begriff Shared decision-making konnte in zahlreichen internationalen Studien gezeigt werden, dass Patienten, die sich in ihre Behandlung einbezogen fühlen, zufriedener sind und bessere Ergebnisse erzielen, als jene, die lediglich passiv die Anweisungen des medizinischen Personals befolgen.

Objectives: The primary aim of this study was to determine if the advice physiotherapists think they provide to patients with low back pain (LBP) is what the patients remember and take away from the clinical encounter. The secondary aim was to determine which factors may influence the retention of this advice. Methods: The first component of the study used questionnaires completed by patients and therapists after the initial visit. Related questionnaires of patients and therapists were screened for inconsistencies. The second component of the study involved semi-structured interviews. Results: Ninety pairs of questionnaires were completed. Therapists provided patients with one (N = 90), two (N = 85) or three (N = 51) items of advice regarding the management of their LBP. All patients remembered the first item of advice, 92% remembered a second, and 67% remembered the third piece of advice. All items of advice were deemed either 'relevant' or 'very relevant' by 97% of the patients. After the analysis of 14 interviews, data saturation was reached. Four themes emerged from the data analysis of the interviews: (a) Evaluation type, (b) Exercise factors, (c) Patient concerns about their diagnosis, and (d) Patient expectations. Discussion: In most cases, patients remembered what therapists told them and considered that the advice provided was relevant. Based on the qualitative data, patients were more likely to remember what therapists said when: (a) shared decision making was used during the initial encounter, (b) prescribed exercises were simple to perform and few in number, (c) patients' concerns about their diagnosis were addressed, and (d) patients' expectations were identified and addressed. K E Y W O R D S communication, low back pain, shared decision making

This paper highlights some of the limitations of models of patient involvement in decision-making and explores the reasons for, and implications of, these limitations. Taking the three models of interpretative, shared and informed decision-making as examples, we focus on two limitations of the models: (1) neglect of which decisions the patient should be involved in (the framing problem) and how the patient should be involved in decision-making (the nature of reasoning problem). Although there will inevitably be a gap between models and practice-this much is in the nature of the models-we suggest that these two issues are substantially neglected by the models and yet are fundamental to understanding patient-doctor decision-making. We also suggest that the fundamental problem that lies behind these limitations is insufficient attention to, and explicitness about, the dilemmas of professional ethics, which are played out in the professional-patient relationships that the models are supposed to represent, particularly with respect to the issue of expert and lay accountability. r

It is easy to feel small, powerless, and unable to spark any sort of change. Being only one person among billions can seem overwhelming indeed. So much is completely beyond our control. There are only a limited set of decisions that people are able to make in life, generally speaking. Given the circumstances, however, there are even fewer decisions that folks will be able to make from here. Of the choices that remain, one involves whether or not we choose to engage in a shared and collaborative practice—of whether or not we are committed to the people in our lives, to the people on this planet, and to the other forms of life on Earth. As such, this is a book about survival in the face of mass extinctions, including those of the academic type. This is a book about ethical research practices, about simple truths, about the commitments we initially made to this work, and about how we might better support each other along the way. Most importantly, this is a book about finding and making our own communities. Communities do not belong to any one person or small group of people. Rather, communities—genuine, real, and vibrant communities—belong to us all. This is a book about how.

Background: Shared decision-making is not widely implemented in healthcare. We aimed to set a research agenda about promoting shared decision-making through continuing professional development. Methods: Thirty-six participants met for two days. Results: Participants suggested ways to improve an environmental scan that had inventoried 53 shared decisionmaking training programs from 14 countries. Their proposed research agenda included reaching an international consensus on shared decision-making competencies and creating a framework for accrediting continuing professional development initiatives in shared decision-making. Conclusions: Variability in shared decision-making training programs showcases the need for quality assurance frameworks.

Calls for a harm threshold to mediate the best interests test have gained momentum following the case of Charlie Gard. This chapter considers normative and empirical claims made by proponents of the harm threshold. While I accept that the best interests test may need of reform, I deny that the harm threshold is the answer. The chapter is divided into two parts. Part one investigates the empirical basis of the claim about parental decision-making in medical practice. It uses an analysis of interviews that reveal some thresholds of decision-making that are volunteered by parents and healthcare professionals in discussions about non-treatment decisions in paediatric intensive care. To some extent I recognise that this data can be used to support the empirical claims made on behalf of the harm threshold. In the second part of the chapter, I take issue with the normative conclusion that this clinical picture means we ought to support the introduction of a harm threshold into medical law. I argue that a harm threshold is largely unmotivated because the current system of decision-making patently does consider the rights of parents as well as children. Proponents of the harm threshold may nevertheless be motivated simply by the desire to make medical law consistent with public law. I argue that there are differences in the level of certainty in clinical and social outcomes, that imply we need significantly more caution when making social welfare decisions. I also note that unintended consequences from the adoption of the harm threshold that may impinge on the rights of parents and increase conflict in the healthcare arena. Finally I argue that the very characterisation of arguments for parental rights as being about liberty is incorrect.

Rationale, aims, and objectives:
The benefits for shared decision-making (SDM) in delivery of high-quality and personalized care are undisputed, but what is it about the dynamics of the delivery room that leads some to doubt that true SDM is possible? How difficult can it be to establish SDM as the norm when caring for a woman in labour? The discussion around SDM, autonomy, and rationality is timely and highly relevant to wider practice.

Method:
The concept of a person's autonomy in decision-making about their body and health is generally accepted and is indeed enshrined in law in many countries. This ought to lay the foundation for SDM in obstetrics. Yet, women's experience speaks to an uncomfortable truth, namely, that it is far from commonplace. We are interested in exploring this tension between the law and the practice.

Results:
We examine a theory of female rationality and its application to women in labour, and juxtapose this with the view from the front line of care delivery. Is a woman in labour able to fully engage in an SDM process? In answering this question, associations in the discourses and practises around women's capacity during labour are revealed, which act as barriers, consciously or unconsciously, to establishing SDM as the norm in obstetrics and midwifery.

Conclusions:
The recent UN report advocating a human rights-based approach to end mistreatment and violence against women in reproductive health services has a particular focus on childbirth and obstetric violence. This paper contributes to the recognition of obstetric violence as a human rights violation. It offers conceptual tools to diagnose the impact of gender stereotypes during childbirth and to eliminate women's discrimination in the field of reproductive health.

Provision of "culturally competent" medical care is one of the strategies advocated for reducing or eliminating racial and ethnic health disparities. This report identifies five domains of culturally competent care that can best be assessed through patients' perspectives: 1) patient-provider communication; 2) respect for patient preferences and shared decision-making; 3) experiences leading to trust or distrust; 4) experiences of discrimination; and 5) linguistic competency. The authors review the literature focusing on these domains, summarize the salient issues and current knowledge, and discuss the policy and research implications. Incorporating patients' perspectives on culturally and linguistically appropriate services into current measures of quality will provide important data and create opportunities for providers and health plans to make improvements.

Determination of subjective weights, which are based on the opinions and preferences of decision-makers, is one of the most important matters in the process of multi-criteria decision-making (MCDM). Step-wise Weight Assessment Ratio Analysis (SWARA) is an efficient method for obtaining the subjective weights of criteria in the MCDM problems. On the other hand, decision-makers may express their opinions with a degree of uncertainty. Using the symmetric interval type-2 fuzzy sets enables us to not only capture the uncertainty of information flexibly but also to perform computations simply. In this paper, we propose an extended SWARA method with symmetric interval type-2 fuzzy sets to determine the weights of criteria based on the opinions of a group of decision-makers. The weights determined by the proposed approach involve the uncertainty of decision-makers' preferences and the symmetric form of the weights makes them more interpretable. To show the procedure of the proposed approach, it is used to determine the importance of intellectual capital dimensions and components in a company. The results show that the proposed approach is efficient in determining the subjective weights of criteria and capturing the uncertainty of information.

Objective: To develop and psychometrically test a brief patient-report instrument for measuring Shared Decision Making (SDM) in clinical encounters. Methods: We revised an existing instrument (Shared Decision Making Questionnaire; SDM-Q), including the generation of new items and changing the response format. A 9-item version (SDM-Q-9) was developed and tested in a German primary care sample of 2351 patients via face validity ratings, investigation of acceptance, as well as factor and reliability analysis. Findings were cross-validated in a randomly selected subsample. Results: The SDM-Q-9 showed face validity and high acceptance. Factor analysis revealed a clearly onedimensional nature of the underlying construct. Both item difficulties and discrimination indices proved to be appropriate. Internal consistency yielded a Cronbach's a of 0.938 in the test sample.

In den letzten Jahren hat der Ansatz der Partizipativen Entscheidungsfindung (PEF) in vielen Ländern zunehmend an Bedeutung gewonnen. Da es sich um ein relativ junges Forschungsgebiet handelt, werden beständig neue Messinstrumente zur Erfassung von PEF (Entscheidungsprozess, Ergebnis und damit einhergehende Konstrukte) entwickelt. Das Ziel dieser Studie war es, eine strukturierte Übersicht über neue Entwicklungen im Bereich der Messung von PEF zu erstellen, einen Überblick über bekannte Skalen zu geben und einen Ausblick auf neue Entwicklungen zu gewähren. Es wurde eine elektronische Literaturrecherche sowie eine Handsuche durchgeführt. Zudem wurden internationale Experten aus dem Forschungsbereich befragt. Gefunden wurden acht bekannte Instrumente, die weiteren psychometrischen Überprüfungen unterzogen wurden, sowie elf neue Skalen und neun unpublizierte Beiträge zu Messinstrumenten. Die Ergebnisse zeigen eine Entwicklung hin zu vermehrter ,,dyadischer Messung'' (Erfassung der Sichtweisen von Arzt und Patient) des PEF-Prozesses. Die internationale Relevanz von PEF wird an der vermehrten Entwicklung nicht-englischer Skalen erkennbar. Bei mehrheitlich guter Reliabilität unterscheiden sich die Instrumente hinsichtlich der Validierungsbemühungen. Zur psychometrischen Überprüfung der meisten Skalen bedarf es weiterer Studien. Zudem wird die Entwicklung eines theoretischen Rahmenkonzepts für PEF-Messungen gefordert, um die Messung der verschiedenen relevanten Konstrukte zu vereinheitlichen. Schlüsselwörter: Partizipative Entscheidungsfindung, Messung, Psychometrie, Reliabilität, Validität, Review (Wie vom Gastherausgeber eingereicht)

What is the state of the research on crowdsourcing for policymaking? This article begins to answer this question by collecting, categorizing, and situating an extensive body of the extant research investigating policy crowdsourcing, within a new framework built on fundamental typologies from each field. We first define seven universal characteristics of the three general crowdsourcing techniques (virtual labor markets, tournament crowdsourcing, open collaboration), to examine the relative trade-offs of each modality. We then compare these three types of crowdsourcing to the different stages of the policy cycle, in order to situate the literature spanning both domains. We finally discuss research trends in crowdsourcing for public policy and highlight the research gaps and overlaps in the literature.

Contracts are designed to govern the relations between business partners and allocate risk among them, yet they cannot mitigate all risks; hence, dispute resolution mechanisms have been developed to assist. According to research, arbitration is considered one of the most efficient legally binding dispute resolution mechanisms. Since initiating an arbitration case against business partners often severs the business relationship between them, predicting the arbitrator's decision becomes valuable to the arbitrating parties. To do so, arbitration prediction models are suggested in this paper through modeling the arbitrator's award in two stages: evidence admissibility and evidence evaluation. While arbitrators currently admit evidence in a relatively unsystematic way, this proposed admissibility framework systemizes the current practice by preserving its subjectivity, yet aligning it with the widely deployed rules of arbitration. This research further proposes an evidence evaluation model, providing a rapid answer to the famous commercial arbitration battle, discovery. While the current arbitrators' practice in allowing discovery is not systematic, the proposed optimization model is a tool that could systematically assist arbitrators trading between the arbitration key characteristic, efficiency, and justice. This is achieved by assigning weights to evidence parameters such as sufficiency and credibility, which in turn provide numerical measures to reduce the decision's subjectivity.

In this chapter I address three questions. First, why is it important to talk about vaginal examinations without consent during labour? Second, what are the barriers to asking and giving consent to vaginal examinations during labour? Third, what can we do to stop vaginal examinations without consent during labour? The philosophical analysis of the history that precedes us adds an illuminating dimension that explains why it is important to deal with unauthorised vaginal examinations during labour: because pregnant women should not so obviously be deprived of their full capacity; because pregnant subjects are still fully entitled subjects; and because women ought not to lose their citizenship just because they enter the maternity ward.
      My conceptual discussion on the barriers that hinder consent looks at the hidden patriarchal premises which, aloof to all real changes in paradigms and praxes, still permeate certain aspects of contemporary obstetrics and midwifery

Background: Theoretical tensions in shared decision-making (SDM) exist among bioethical principles, patient autonomy, and evidence-based medicine. Scholars in biomedicine have looked to empathy as a component of SDM that may assist in decreasing these conflicts.

Method: This article outlines a theoretical foundation for incorporating relational empathy in SDM. Informed by interpersonal communication theory and bioethics, relational empathy becomes an intrinsic component in the initial phase of SDM.

Results: Healthcare providers should consider developing relational empathy with their
patients before they address treatment options. Relational empathy, especially in the context of values elicitation and clarification, may increase patient participation and provide more symmetrical communication opportunities. Relational empathy also assists in developing relational autonomy, which shifts the emphasis in SDM from the traditional bioethical view of the autonomous individual to a definition of autonomy that describes a person in relation with others.

Conclusion: Increased opportunities for relational empathy through interpersonal
communication may provide a more ethical communication context for SDM.

This thesis explores the application of the concept relationskompetence for general practitioners in general practice as an institution. Relationskompetence is a Danish term which has no direct English correlate, but overlaps terms such as “interpersonal skills” and “empathy” among others. Lægeløftet (Danish equivalent of the The Hippocratic Oath) states the prerequisite for GP’s ability to act according to ethical obligations upon entering the medical establishment, though not limited to general practice as an institution. This thesis investigates how relationskompetence can be of use for GPs to act in accordance with the ethical obligations and principles which is rooted in general practice as an institution. The investigation contains three parts, each part devoted to a different aspect of the application of relationskompetence. The first part is devoted to an analysis and discussion of the theoretical comparability of the concept with general practice, which will culminate in a definition of relationskompetence in relation to general practice as an institution. There will be a focus on time and asymmetry. The second part is devoted to empirical analysis of interactions between doctor and patient during consultations, using the methodical device developed in the first part. The findings point to an application of relationskompetence for GPs working under time and asymmetry as conditions in general practice as an institution. The third part is devoted to a discussion of the application of relationskompetence in relation to existing studies on interaction between doctors and their patients, where the focus on time and asymmetry will pertain. This part will contain suggestions on which fields of study the investigation can contribute. This thesis will conclude on the basis of all three parts, that there indeed is a use for relationskompetence in general practice, in regard to combining the institution with this methodical approach to analyse and point out how GPs can live up to the ethical obligations they work under.

Writing and Unrecognized Academic Labor acknowledges that much of the work we do to sustain the academy remains without recognition. It demonstrates that it is not only published work that influences development and innovation in scholarship. The book rethinks the "publish or perish" system to show that good, unrecognized work is a vital part of scaffolding the growth of the academy and individual academic careers. It takes openness and transparency as a blueprint to outline plans for not only producing but also reimagining key markers of academic life, such as dissertations without anxieties of influence, conferences without directors, journals without gatekeepers, large-sample peer review, and teaching and learning beyond the university discourse. A sustainable community model of academic life should have belonged to each of us from the start.

Effective policy mixes are expected to accommodate uncertainties in the future policy context by being flexible and adapt over time in expectation of a range of anticipated and unanticipated conditions. In response to shifts in the future policy context, while policy changes can manifest as increments to status quo over time, policymakers may also need to face the possibility of making major policy shifts to enable the transition into more appropriate policy regimes. In the context of socio-technical transitions, the switch to new policy alternatives can be facilitated by incorporating new policy actions into the suite of current policy strategies early on, which can also help accommodate the long lead-times on some decisions and actions. This paper is a conceptual piece that focuses on integrating policy design thinking into the crafting of conscious policy choices and mixes to enable socio-technical transitions while considering the likely changes in the future policy context.

This review is one of a series of articles reflecting the sections of the Code of Ethics of the American Society for Surgery of the Hand. The physician-patient relationship has been subjected to numerous stressors over the past several decades. This report reviews historical elements of the relationship and discusses current issues related to it: asymmetry, challenges to the physician, and interpersonal, systemic, and societal challenges. (J Hand Surg 2010;35A:2126-2129

"This paper presents a systematic account of ethical issues actualised in different areas, as well as at different levels and stages of health care, by introducing organisational and other procedures that embody a shift towards person centred care and shared decision-making (PCC/SDM). The analysis builds on general ethical theory and earlier work on aspects of PCC/SDM relevant from an ethics perspective.
This account leads up to a number of theoretical as well as empirical and practice oriented issues that, in view of broad advancements towards PCC/SDM, need to be considered by health care ethics researchers. Given a PCC/SDM-based reorientation of health care practice, such ethics research is essential from a quality assurance perspective."

Healthcare systems are in the process of reforming themselves to better meet the needs of people with, or at risk of developing, chronic diseases and long term conditions. One goal of these efforts is the coproduction of activated, informed, engaged and motivated patients and citizens. The clinical, public health and financial benefits of achieving such a goal may be dramatic. Motivational Interviewing (MI) is a proven and practical front-line approach which can help deliver this goal whilst also helping to deliver such policy objectives and intermediate outcomes as increased levels of patient centered care, participatory or shared decision making, evidence-based healthcare and improved clinician-patient relationships. Until now, MI has been passively diffusing through the system as a result of the innovation and early uptake by insightful individuals and organizations. If healthcare systems want to breakthrough to higher levels of performance, investment in the conscious and deliberate implementation of MI into front-line settings may prove helpful.

The PACT (Preferences and Advance decisions for Crisis and Treatment) is a fillable template for advance decision making in fluctuating mental health conditions. For more details on how it was produced see preprint of ‘Stephenson, L.*, Gergel, T.*, Ruck Keene, A., Rifkin, L., & Owen, G. (2020). The PACT advance decision-making template: Preparing for mental health act reforms with co-production, focus groups and consultation. International Journal of Law and Psychiatry (https://www.researchgate.net/publication/342305448_The_PACT_advance_decision-making_template_preparing_for_Mental_Health_Act_reforms_with_co-production_focus_groups_and_consultation)