The Opportunities and Challenges for Shared Decision-Making in the Rural United States
- 276 Downloads
The ethical standard for informed consent is fostered within a shared decision-making (SDM) process. SDM has become a recognized and needed approach in health care decision-making. Based on an ethical foundation, the approach fosters the active engagement of patients, where the clinician presents evidence-based treatment information and options and openly elicits the patient’s values and preferences. The SDM process is affected by the context in which the information exchange occurs. Rural settings are one context that impacts the delivery of health care and SDM. Rural health care is significantly influenced by economic, geographical and social characteristics. Several specific distinctive features influence rural health care decision-making—poverty, access to health care, isolation, over-lapping relationships, and a shared culture. The rural context creates challenges as well as fosters opportunities for the application of SDM as a natural dynamic within the rural provider–patient relationship. To fulfill the ethical requirements of informed consent through SDM, it is necessary to understand its inherent challenges and opportunities. Therefore, rural clinicians and ethicists need to be cognizant of the impact of the rural setting on SDM and use the insights as an opportunity to achieve SDM.
KeywordsEthics Health care ethics Shared decision-making Informed consent Rural health care
The authors want to express their appreciation for the thoughtful insights offered by members of the Vermont Ethics Network; also, Drs. Don Kollisch, Robert Macauley, Denise Niemira, and Cathleen Morrow; Ms. Robin Paradis Montibello and Ms. Linnea Spelman in preparing the manuscript.
- Alston, C., Elwyn, G, et al. (2014). Shared decision-making strategies for best care: Patient decision aids. Institute of Medicine Discussion Paper. Retrived from: http://www.iom.edu/Global/Perspectives/2014/SDMforBestCare.aspx. Accessed 15 Apr 2015.
- American Medical Association. (2010). Getting the most for our health care dollars: Shared decision-making. Retrieved from: http://www.allhealth.org/briefingmaterials/AMASharedDecisionMaking-1936.pdf. Accessed 15 Apr 2015.
- Bushy, A. (2010). Ethics conflicts in rural communities: Shared decision-making. In W. A. Nelson (Ed.), Handbook for rural health care ethics: A practical guide for professionals (pp. 16–40). Hanover: Dartmouth College Press.Google Scholar
- Bushy, A. (2014). Rural health care ethics. In J. C. Warren & K. B. Smalley (Eds.), Rural public health (pp. 41–54). New York: Springer.Google Scholar
- Cook, A. F., & Hoas, H. (2001). Voices from the margins: A context for developing bioethics-related resources in rural areas. American Journal of Bioethics, 1(4), W12.Google Scholar
- Department of Health. (2012). Liberating the NHS, No decision about me without me. Retrieved from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216980/Liberating-the-NHS-No-decision-about-me-without-me-Government-response.pdf. Accessed 15 Apr 2015.
- Elwyn, G. (2014) Grant B14-06, Integrating Shared Decision Making and Interprofessional Education. Josiah Macy Jr. Foundation. Retrieved from: http://macyfoundation.org/grantees/profile/integrating-shared-decision-making-and-interprofessional-education. Accessed 15 Apr 2015.
- King, J. S., & Moulton, B. W. (2006). Rethinking informed consent case for shared medical decision making. American Journal of Law and Medicine, 32, 429–501.Google Scholar
- Morrow, C. E., Reed, V. A., Eliassen, M. S., & Imset, I. (2011). Shared decision making : III medical students. Family Medicine, 43(10), 721–725.Google Scholar
- National Rural Health Care Association (NRHA). (2014) Retrieved from: http://www.ruralhealthweb.org/go/left/about-rural-health/what-s-different-about-rural-health-care. Accessed 15 Apr 2015.
- Nelson, W. (2004). Addressing rural ethics issues. The characteristics of rural healthcare settings pose unique ethical challenges. Healthcare Executive, 19(4), 36–37.Google Scholar
- Nelson, W. A. (2008). Rural health care ethics: An overview. In C. Krugman & P. M. Dalinis (Eds.), Rural ethics handbook (pp. 34–50). Baltimore: The Hopkins Press.Google Scholar
- Nelson, W. A. (2010). Health care ethics and rural life: Stigma, privacy, boundary conflicts raise concerns. Health Progress, 91(5), 51–54.Google Scholar
- Nelson, W. A., & Clay, K. (2011). Imperfect informed consent. Healthcare Executive, 26(4), 52–55.Google Scholar
- Niemira, D. (2010). Ethics conflicts in rural communities: Shared decision-making. In W. A. Nelson (Ed.), Handbook for rural health care ethics: A practical guide for professionals (pp. 149–159). Hanover: Dartmouth College Press.Google Scholar
- O’Connor, A. M., & Edwards, A. (2009). The role of decision aids in promoting evidence based patient choice. In A. Edwards & G. Elwyn (Eds.), Shared decision-making in health care: Achieving evidence-based patient choice (pp. 191–200). Oxford: Oxford University Press.Google Scholar
- Pomerantz, A. (2010). Ethics conflicts in rural communities: Overlapping Roles. In W. A. Nelson (Ed.), Handbook for rural health care ethics: A practical guide for professionals (pp. 107–124). Hanover: Dartmouth College Press.Google Scholar
- Pope, T. M., & Hexum, M. (2013). Legal briefing: Shared decision making and patient decision aids. Journal of Clinical Ethics, 24, 70–80.Google Scholar
- United States Census (2010) https://ask.census.gov/faq.php?id=5000&faqId=5971. Accessed 15 Apr 2015.
- United States Congress. (2010). Patient protection and afforable care act. http://www.hhs.gov/healthcare/rights/law/patient-protection.pdf. Accessed 15 Apr 2015.
- WWAMI RUCA Rural Health Research Center. Retrieved 2014 http://depts.washington.edu/uwruca/ruca-maps.php. Accessed 15 Apr 2015.
- Ziller, E. (2014). Access to medical care in Rural America. In J. C. Warren & K. B. Smalley (Eds.), rural public health (pp. 11–28). New York: Springer.Google Scholar