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Neurologists make treatment decisions every day; there is a strong ethical case (patient autonomy) for making these decisions jointly with patients.1 ,2 Patients must clearly be closely involved in high-stakes decisions, such as starting chemotherapy and/or radiotherapy for malignant glioma. But there are many lower-stakes decisions where shared decision making can optimise and improve outcomes. Furthermore, there is strong political pressure for efficiency, ensuring the right patients receive the right treatment.3 Thus, patients, policy makers and clinicians each support the principle of shared decision making.1–3 Joint decision making also makes sense from a health and well-being point of view; we feel relatively better when we have more control over events in our lives.
Decision support tools
Although good shared decision making is hard to define and to measure, how we share a decision is very important.2 In particular, ‘patient decision support tools’ can positively impact the quality of treatment decisions. A Cochrane review of such tools (2011 update including 86 randomised controlled trials) showed that increased patient knowledge and improved patient perception of risk helped to ensure that decisions were ‘more congruent’ with patient preferences.4 This research, coupled with the broad public and professional support for shared decision making, suggests clinicians should reconsider how they reach decisions with their patients, and whether they could do better. Option Grids provide …
Contributors RPS drafted and revised the paper, and revised the draft Option Grid discussed in the paper. He is guarantor. JK drafted the Option Grid discussed in the paper and revised the draft paper. GE conceived the Option Grid idea, revised the Option Grid discussed in the paper and revised the draft paper. PEMS conceived the paper, revised the draft Option Grid discussed in the paper and revised the draft paper.
Competing interests We have read and understood the BMJ Group policy on declaration of interests and declare the following interests: RPS: No conflicts of interest to declare. JK: No conflicts of interest to declare. GE: No conflicts of interest to declare. PEMS is co-editor of Practical Neurology.
Provenance and peer review Commissioned, externally peer reviewed. This paper was reviewed by Mark Manford, Cambridge, UK.
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