Die Gestaltung der Arzt-Patienten-Beziehung in Abhängigkeit von der Behandlungssituation

Shared decision making (SDM) has to be distinguished from paternalistic decision making and informed patient choice. In bioethics SDM is often advocated as an ideal for medical decision making. However, up to now there has been no systematic investigation in which treatment situations SDM is suitable. This dissertation addresses this question by investigating social norms on the appropriateness of SDM in different situations. Using a problem-centered focus in a first step, qualitative expert interviews with patients, general practitioners and professionals in health administration and research were conducted. Based on these interviews, in a second step, a factorial survey consisting of 7 factors (e.g. the reason for consultation) with 2-3 levels (e.g. one reasonable option vs. more than one option) was constructed. In total 101 family physicians, 115 patients and 113 members of self-help groups participated in the factorial survey study. This dissertation reveals that there is a general desire for SDM from a normative point of view. Findings allow for definition of situations where SDM is especially important. Furthermore, results show that norms in medical decision making are highly influenced by personal preferences.