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Patient-centered care and shared decision-making: challenges and proposed approaches

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Introduction: Patient-centered care allows a shared and active involvement of patients and their families in clinical decisions, where individual patient characteristics, preferences, needs, and values are considered. Big challenges have been faced worldwide to enable the patient-centered care to become a common practice in private and public healthcare systems. Challenges and Proposed Approaches: Some authors consider that most evidence-based approaches must be at odds, as it focus on populations, and not on individual needs and values. Outcomes based on these attributes must be defined. Another challenge is how to minimize the information asymmetry. Clinical guidelines, technical reports, systematic reviews, and modeling results must be synthesized and translated to a friendly/accessible language. Risks, benefits and economic implications of each option for treatment should be clearly presented. By this way, the patient becomes more compromised with the consequences of his choice. Another challenge pointed by many authors is the poor relationship between patients and physicians. Physicians must be encouraged to improve the quality of relationship with their patients, which greatly determines both treatment outcomes, patient’s satisfaction, adherence to treatment and involvement, and costs. A crucial challenge implies in an dramatic change of paradigms. Shared decision-making should be systematically encouraged in public and private healthcare. For the former, new healthcare models should be designed and implemented through an active engagement of patients and consumers. Conversely, for the latter, all stakeholders, including the patients, should have active voice during the discussion of new reimbursement and coverage policies. Conclusions: A few countries have already found ways to face most of these challenges, but we´re still far away from an ideal world where sparse resources are rationally allocated in healthcare through a participative, shared, and patient-centered way.