of whether patients are able to choose their providers, individuals can still exercise choice by selecting among different treatment approaches, medications, and strategies for treating and recovering from their illness. Patients should be supported in expressing their treatment preferences and having them incorporated into treatment decision making. Supporting decision making and treatment preferences requires that patients have information on the various treatment options available.

Providing information about the benefits and risks of different treatment options Information needs to be available to consumers to support their decision making and to promote their exercise of choice. Clinicians and their sponsoring health care organizations should provide patients with information (in a user-friendly format) about the comparative effectiveness of different treatment approaches (regardless of whether those approaches are offered by the clinician or health care organization) and any risks/contraindications/side effects that may be present given the patient’s clinical profile. When information on the comparative effectiveness of different treatment approaches is not available (see the discussion of the limited evidence base in Chapter 4), this lack of information should be made known to the consumer. Patients should also be given information on whether a specific therapeutic approach is available from their clinician, organization, or health plan.

Providing decision support to all patients It is widely acknowledged that all clinicians need support in their clinical decision making to stay abreast of recent developments in therapeutics. If patient are truly to share in clinical decision making, it is likely that they, too, will need information to support that decision making. However, decision-support tools are just beginning to be used in general health care to help consumers select among different treatment options for a limited number of medical conditions, for example, problems with vision or specific diseases such as benign prostatic hypertrophy (Stanton, 2002). Consumers of M/SU health care services also need such decision-support tools, although their availability is currently very limited.

In the interim, clinicians and health care organizations can support all M/SU consumers in their decision making by (1) providing them with the information described above (in a user-friendly format); (2) avoiding undermining their decision-making abilities (verbal support is effective in increasing individuals’ belief in their ability to make treatment decisions, or their self-efficacy; see the discussion earlier in this chapter [Bandura, 1997b]); and (3) appreciating the changing nature of consumers’ decision-making preferences. The Quality Chasm report, for example, underscores that shared decision making is a dynamic process that changes as patients’

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