From information to shared decision‐making in medicine

As stated by Angela Coulter in one of her leading articles, ‘Most readers of Health Expectations will be familiar with the now extensive body of research into shared decision-making, including patients’ information needs, the evaluation and use of patient decision aids, and strategies for training health professionals to elicit patients’ values and preferences and engage them in decisions about their care.’1 Indeed, this journal has now been engaged for over 5 years in making shared decision-making studies known internationally. We are grateful to the editorial board of the journal for agreeing to publish this special issue on work presented at the international meeting ‘From information to shared decision-making in medicine’ that was organized in Lyons (France) in December 2002, as part of the 15th Entretiens Jacques Cartier. From the early nineties, publications dealing with information and shared decision-making in the context of the doctor–patient relationship, as well as in medicine in general, have reported studies conducted by multidisciplinary teams including physicians, sociologists, ethicists, psychologists and economists, mostly from Northern America, Australia and Northern Europe. Although French researchers have been less involved in this domain of research, a number of publications have emerged from France since the end of the nineties, dealing either with legal or administrative aspects,2–7 or with scientific information.8–13 In this context, we were keen to invite international and French specialists involved in the domain from the very beginning to participate in the meeting. The occasion gave us an opportunity to discuss current advances and future prospects, and also to promote the theme of patient information and shared decision-making in our country. Several very exciting communications were made. A list of the different contributions is given below (in alphabetical order of authors): Janine Barbot and Emmanuelle Fillion: How is medical decision-making shared? The case of haemophilia patients and doctors: the aftermath of the infected blood affair in France. Carlos Brailowsky: Competence certification in family medicine: impact of shared decision-making. Alain Brémond: Clinical issues in shared decision-making applied to breast cancer. Dominique Broclain: Observed roles of hospitalized patients in medical decision-making. Marie-France Callu: Shared decision-making in medicine: a central issue in the French legal system. Angela Coulter: Shared decision-making: the next steps. Hanneke De Haes: Does patient-centred medicine represent the ideal world? Adrian Edwards: The contribution of risk communication to medical decision-making: what does it achieve and how should we do? France Légaré: Clinical decision-making in hormone replacement therapy: agreement of women and their doctor. Amiram Gafni: The physician–patient encounter: an economic perspective. Andrew Kennedy: Information is not enough: the information and preferences in Menorrhagia (IPMEN study). Nora Moumjid: Shared decision-making in the medical encounter: is there persisting confusion about what it means? Annette O'Connor: Progress and prospects in implementing patient decision aids. Tim Whelan: Helping women make informed choices: the evolving role of the decision board. This special issue of Health Expectations includes papers from several participants at the meeting. Adrian Edwards and colleagues explore shared decision-making and risk communication in the doctor–patient consultation. They also show how important it is to involve consumers and patients, if one aims to conduct effective research in the field of patient-centred health-care. Emmanuelle Fillion analyses the sociological aspects of shared decisions in the particular setting of the HIV-contaminated blood affair in France. France Légaré, through a multilevel regression analysis, explores factors associated with the difference in scores between women and physicians in their decisional conflict about hormone therapy. Andrew Kennedy, through an analysis of published systematic reviews of decision aid randomized controlled trials, raises the question of the basis on which the effectiveness of decision aids should be judged. Finally, our study of patients with breast cancer attempts to assess the feasibility of shared decision-making in common clinical practice in France. We wish you a good reading. We hope this special issue will bring you as much pleasure as we had preparing it.