you will share your experience (see below for experience) and consider the impact of patient involvement (or lack of involvement). You will also consider the use of a patient decision aid to inform best practices for patient care and healthcare decision making.

350 word discussion. At least 2 References ( I have attached some to utilize) within last 5 years and cited in discussion. Apa format

-Review the Resources (I attached articles) and reflect on a time when you experienced a patient being brought into (or not being brought into) a decision regarding their treatment plan. 

-This is the experience: Treatment is limited for patient with stage 4 cancer and they are considering going on hospice to have better quality life. (you can include any details you would like)

-Review the Ottawa Hospital Research Institute’s Decision Aids Inventory at

Choose “For Specific Conditions,” then Browse an alphabetical listing of decision aids by health topic. Type in ‘hospice’

Try to use this link to take you right to the hospice link on that site

The discussion:

-Post a brief description of the situation you experienced and explain how incorporating or not incorporating patient preferences and values impacted the outcome of their treatment plan. Be specific and provide examples

-Then, explain how including patient preferences and values might impact the trajectory of the situation and how these were reflected in the treatment plan. 

-Finally, explain the value of the patient decision aid you selected and how it might contribute to effective decision making, both in general and in the experience you described. Describe how you might use this decision aid inventory in your professional practice or personal life.-you have to reference and use the decision aid site listed above.


Here are references attached

Schroy, P. C., Mylvaganam, S., & Davidson, P. (2014). Provider perspectives on the utility of a colorectal cancer screening decision aid for facilitating shared decision making. Health Expectations, 17(1), 27–35. doi:10.1111/j.1369-7625.2011.00730.x

Kon, A. A., Davidson, J. E., Morrison, W., Danis, M., & White, D. B. (2016). Shared decision making in intensive care units: An American College of Critical Care Medicine and American Thoracic Society policy statement. Critical Care Medicine, 44(1), 188–201. doi:10.1097/CCM.0000000000001396

Hoffman, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision making. Journal of the American Medical Association, 312(13), 1295–1296. doi:10.1001/jama.2014.10186

Copyright 2014 American Medical Association. All rights reserved.

The Connection Between Evidence-Based
Medicine and Shared Decision Making

Evidence-based medicine (EBM) and shared decision
making (SDM) are both essential to quality health care,
yet the interdependence between these 2 approaches
is not generally appreciated. Evidence-based medicine
should begin and end with the patient: after finding
and appraising the evidence and integrating its infer-
ences with their expertise, clinicians attempt a deci-
sion that reflects their patient’s values and circum-
stances. Incorporating patient values, preferences, and
circumstances is probably the most difficult and poorly
mapped step—yet it receives the least attention.1 This
has led to a common criticism that EBM ignore s
patients’ values and preferences—explicitly not its

Shared decision making is the process of clinician
and patient jointly participating in a health decision af-
ter discussing the options, the benefits and harms, and
considering the patient’s values, preferences, and cir-
cumstances. It is the intersection of patient-centered
communication skills and EBM, in the pinnacle of good
patient care (Figure).

One Without the Other?
These approaches, for the most part, have evolved in
parallel, yet neither can achieve its aim without the other.
Without SDM, authentic EBM cannot occur.3 It is a
mechanism by which evidence can be explicitly brought
into the consultation and discussed with the patient.
Even if clinicians attempt to incorporate patient prefer-
ences into decisions, they sometimes erroneously
guess them. However, it is through evidence-informed

deliberations that patients construct informed prefer-
ences. For patients who have to implement the deci-
sion and live with the consequences, it may be more per-
tinent to realize that it is through this process that
patients incorporate the evidence and expertise of the
clinician, along with their values and preferences, into
their decision-making. Without SDM, EBM can turn into
evidence tyranny. Without SDM, evidence may poorly
translate into practice and improved outcomes.

Likewise, without attention to the principles of EBM,
SDM becomes limited because a number of its steps are
inextricably linked to the evidence. For example, discus-
sions with patients about the natural history of the con-
dition, the possible options, the benefits and harms of
each, and a quantification of these must be informed by

the best available research evidence. If SDM does not in-
corporate this body of evidence, the preferences that pa-
tients express may not be based on reliable estimates
of the risks and benefits of the options, and the result-
ing decisions not truly informed.

Why Is There a Disconnect?
A contributor to the existing disconnect between EBM
and SDM may be that leaders, researchers, and teach-
ers of EBM, and those o

Provider perspectives on the utility of a colorectal
cancer screening decision aid for facilitating shared
decision making

Paul C. Schroy III MD MPH,* Shamini Mylvaganam MPH� and Peter Davidson MD�
*Director of Clinical Research, Section of Gastroenterology, Boston Medical Center, Boston, MA, �Study Coordinator, Section of
Gastroenterology, Boston Medical Center, Boston, MA and �Clinical Director, Section of General Internal Medicine, Boston
Medical Center, Boston, MA, USA


Paul C. Schroy III, MD MPH

Boston Medical Center

85 E. Concord Street

Suite 7715


MA 02118


E-mail: [email protected]

Accepted for publication

8 August 2011

Keywords: decision aids, informed
decision making, shared decision



Background Decision aids for colorectal cancer (CRC) screening

have been shown to enable patients to identify a preferred screening

option, but the extent to which such tools facilitate shared decision

making (SDM) from the perspective of the provider is less well


Objective Our goal was to elicit provider feedback regarding the

impact of a CRC screening decision aid on SDM in the primary care


Methods Cross-sectional survey.

Participants Primary care providers participating in a clinical trial

evaluating the impact of a novel CRC screening decision aid on

SDM and adherence.

Main outcomes Perceptions of the impact of the tool on decision-

making and implementation issues.

Results Twenty-nine of 42 (71%) eligible providers responded,

including 27 internists and two nurse practitioners. The majority

(>60%) felt that use of the tool complimented their usual approach,

increased patient knowledge, helped patients identify a preferred

screening option, improved the quality of decision making, saved

time and increased patients� desire to get screened. Respondents
were more neutral is their assessment of whether the tool improved

the overall quality of the patient visit or patient satisfaction. Fewer

than 50% felt that the tool would be easy to implement into their

practices or that it would be widely used by their colleagues.

Conclusion Decision aids for CRC screening can improve the

quality and efficiency of SDM from the provider perspective but

future use is likely to depend on the extent to which barriers to

implementation can be addressed.

doi: 10.1111/j.1369-7625.2011.00730.x

� 2011 John Wiley & Sons Ltd 27
Health Expectations, 17, pp.27–35


Shared Decision-Making in Intensive Care Units
Executive Summary of the American College of Critical Care Medicine and
American Thoracic Society Policy Statement

Shared decision-making is a central component of patient-centered
care in the intensive care unit (ICU) (1–4); however, there remains
confusion about what shared decision-making is and when
shared decision-making ought to be used. Further, failure to
employ appropriate decision-making techniques can lead to
significant problems. For example, if clinicians leave decisions
largely to the discretion of surrogates without providing adequate
support, surrogates may struggle to make patient-centered
decisions and may experience psychological distress (5).
Conversely, if clinicians make treatment decisions without
attempting to understand the patient’s values, goals, and
preferences, decisions will likely be predominantly based on the
clinicians’ values, rather than the patient’s, and patients or
surrogates may feel they have been unfairly excluded from
decision-making (1, 2). Finding the right balance is therefore
essential. To clarify these issues and provide guidance, the
American College of Critical Care Medicine (ACCM) and
American Thoracic Society (ATS) recently released a policy
statement that provides a definition of shared decision-making
in the ICU environment, clarification regarding the range of
appropriate models for decision-making in the ICU, a set of skills
to help clinicians create genuine partnerships in decision-making
with patients/surrogates, and ethical analysis supporting the
findings (6).

To develop a unified policy statement, the Ethics Committee of
the ACCM and the Ethics and Conflict of Interest Committee of the
ATS convened a writing group composed of members of these
committees. The writing group reviewed pertinent literature
published in a broad array of journals, including those with a focus
in medicine, surgery, critical care, pediatrics, and bioethics, and
discussed findings with the full ACCM and ATS ethics committees
throughout the writing process. Recommendations were generated
after review of empirical research and normative analyses published
in peer-reviewed journals. The policy statement was reviewed,
edited, and approved by consensus of the full Ethics Committee
of the ACCM and the full Ethics and Conflict of Interest Committee
of the ATS. The statement was subsequently reviewed and approved
by the ATS, ACCM, and Society of Critical Care Medicine leadership,
through the organizations’ standard review and approval processes.

ACCM and ATS endorse the following definition: Shared
decision-making is a collaborative process that allows patients, or
their surrogates, and clinicians to make health care decisions
together, taking into account the best scientific evidence
available, as well as the patient’s values, goals, and preferences.

Clinicians and patients/surrogates should use a sha