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Ideas and Opinions |

Promoting Informed Choice: Transforming Health Care To Dispense Knowledge for Decision Making

Steven H. Woolf, MD, MPH; Evelyn C.Y. Chan, MD, MS; Russell Harris, MD, MPH; Stacey L. Sheridan, MD, MPH; Clarence H. Braddock III, MD, MPH; Robert M. Kaplan, PhD; Alex Krist, MD; Annette M. O'Connor, RN, MScN, PhD; and Sean Tunis, MD, MSc
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From Virginia Commonwealth University, Richmond, Virginia; University of Texas–Houston School of Medicine, Houston, Texas; University of North Carolina School of Medicine, Chapel Hill, North Carolina; Stanford University School of Medicine, Stanford, California; UCLA School of Public Health, Los Angeles, California; University of Ottawa, Ottawa, Ontario, Canada; and Centers for Medicare & Medicaid Services, Baltimore, Maryland.

Acknowledgments: The authors thank Angela Coulter, PhD; Joanne Lynn, MD; Albert G. Mulley Jr., MD; James Weinstein, DO, MSc; and the anonymous reviewers for their helpful comments on earlier drafts of this manuscript.

Potential Financial Conflicts of Interest: Grants received: R.M. Kaplan (Foundation for Informed Medical Decision Making), A. Krist (American Academy of Family Physicians), A.M. O'Connor (Foundation for Informed Medical Decision Making).

Requests for Single Reprints: Steven H. Woolf, MD, MPH, Departments of Family Medicine, Epidemiology, and Community Health, Virginia Commonwealth University, West Hospital, 1200 East Broad Street, P.O. Box 980251, MCV Station, Richmond, VA 23298-0251; e-mail, swoolf@vcu.edu.

Ann Intern Med. 2005;143(4):293-300. doi:10.7326/0003-4819-143-4-200508160-00010
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Ours is an era in which patients seek greater engagement in health care choices, increasing the demand for high-quality information about clinical options. Providing support for informed choice is not straightforward, however, because of challenges faced by clinicians, health systems, and consumers. Greater use of written or electronic tools can help to clarify choices for patients, but decision aids cannot replace the human element in facilitating informed choice. The ideal solution is to couple information with high-quality decision counseling to help patients understand the potential risks, benefits, and uncertainties of clinical options and to assist them in selecting the option that best accommodates their personal preferences. Decision counseling can be offered by 3 types of providers: clinicians who lack formal informed-choice training (“usual care”), clinicians with formal informed-choice training, or trained third parties who function as impartial decision counselors. Controlled studies are needed to determine which model is best, but none appears to be ideal.The health care system cannot truly support informed decision making without correcting the underlying obstacles that impede patient access to needed information. New information technology solutions, training programs, and reimbursement schemes are necessary. Patient demand for guidance will only increase as clinical options multiply and the world of information continues its rapid growth. Today's health care system is unprepared for the convergence of these 2 burgeoning domains, and the need to address systemic deficiencies will grow more urgent over time.





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