DECISION-MAKING IN WOMENS HEALTH-CARE

The components of informed consent that allow patients to make and communicate a choice that most likely will meet their goals include the nature of the illness and treatment, probabilities of successfully achieving the benefits, risks, costs, and alternatives. Research generally shows that physicians' verbal information sharing, educational materials, checklists, and encouragement of question asking are associated with improvements in patients' knowledge, control, health status, and adherence to and satisfaction with treatment. Two general suggestions for clinical practice emerge from this review of the literature. First, congruence of physicians' and patients' understanding of the elements of informed consent can be facilitated by joint decision-making tools, e.g., the PREPARED(TM) model and the Ballard-Reisch model. Second, provision of informed consent information, including the use of patient-centered models that most empower patients and respect their autonomy, is most effective when done with sensitivity to various individual differences, which are summarized in Table 3. These factors may change over time as patients' value preferences and expectations for health outcomes vary with changes in their lives, e.g., health status, construction of the meaning of their illness, and needs of social network members. Patient-centered models of informed consent offer ways to match information provision with patients' individual differences and preferences in a manner that allows flexibility in adapting to changes. The open discussion of the elements of informed consent inherent in these models allows patients and physicians to more easily: 1. identify individual differences and preferences in an early and ongoing manner; 2. assess the extent of agreement of understanding and readily remedy any misunderstandings; and 3. anticipate and negotiate any changes as they occur and adjust treatment accordingly. Finally, patient-oriented models of informed consent provide safeguards against the potential negative consequences of judgment heuristics or biases. These models allow a more open and flexible process to identify any undesirable effects of heuristics used by physicians or patients; check for agreement of understanding; and provide a path for returning to more appropriate rational decision-making.