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Difficulties in judging patient preferences for shared decision-making
  1. Alexander A Kon
  1. University of California San Diego and Naval Medical Center San Diego, San Diego, California, USA
  1. Correspondence to Dr Alexander A Kon, 34800 Bob Wilson Drive, Building 1, 2nd Floor, Pediatric Intensive Care Unit (PICU), San Diego, CA 92134, USA; kon.sandiego{at}

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Shared decision making has been officially supported by every major critical care organisation in the USA and Europe, the American Medical Association, the American Academy of Pediatrics, and others.1–3 Indeed, the first recommendation in the American College of Critical Care Medicine's guidelines for family support is that healthcare providers should partner with families in making difficult choices.4 In the USA and elsewhere, too often have doctors shied away from active participation in decision making due to a mistaken belief that value-laden decisions should be made only by patients or their surrogate decision makers.1

In order to provide optimal care, doctors must be willing and able to bear some, or at times the majority, of the burden when difficult decisions must be made. Indeed, shared decision making is best understood as a continuum ranging from patient-driven decision making, through an equal partnership with care providers, to fully physician-driven decision making.5 How the team of patient, family and providers balance the burdens and responsibilities of decision making should generally be driven by the wishes of the patient or the surrogate decision maker.

Empirical research supports the need for flexibility in decision making. Data from US studies show that most people want their doctor to be an active participant in value-laden decision making.6 ,7 Indeed, these studies report that about 1 in 10 people prefer that the doctor makes the major decisions, including the decision to continue life-prolonging therapies, or …

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  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.

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