Decision Making: A Variety Of Models For Making Decisions

Decision Making a Variety Of Models For Making Decisions Are Available

Decision-making models are crucial frameworks used in various contexts, including healthcare, business, and personal choices, to facilitate effective and ethical outcomes. Among the widely discussed models are the paternalistic, informative, and shared decision-making approaches. Each model has unique advantages and disadvantages, making them suitable for different circumstances. This paper discusses the pros and cons of each model and evaluates which is most likely to result in permanent change, supported by current academic literature.

Pros and Cons of Paternalistic, Informative, and Shared Decision-Making Models

Paternalistic Decision-Making

The paternalistic model is characterized by the healthcare professional making decisions on behalf of the patient, based on their expertise and judgment, with minimal input from the patient. This approach has historical roots and stems from the assumption that professionals know what is best for the patient, similar to a parent-child dynamic.

Pros: The primary advantage of the paternalistic model lies in its efficiency and decisiveness, particularly in emergency situations where swift decisions are necessary. It minimizes patient anxiety by streamlining the decision process and can be beneficial when patients lack sufficient knowledge to make informed choices, such as in cases of cognitive impairment or critical illness (Charles et al., 1997).

Cons: The major drawbacks include the risk of undermining patient autonomy and engagement, potentially leading to dissatisfaction and mistrust. It can result in decisions that do not align with the patient’s values or preferences, thereby reducing long-term adherence to treatment and satisfaction (Braddock et al., 1999).

Informative Decision-Making

In the informative model, healthcare professionals provide patients with all relevant information about options, risks, and benefits, leaving the final decision entirely up to the patient. This model emphasizes autonomy and informed consent.

Pros: The informative approach respects patient autonomy and promotes empowerment, enabling individuals to make choices aligned with their values and preferences (Entwistle et al., 2010). It is particularly suitable for patients who desire full control over their healthcare decisions or have a good understanding of medical information.

Cons: The significant challenge with this model is the assumption that patients can comprehend complex medical information, which is not always feasible. It may lead to decisional conflict, anxiety, or decisional paralysis, especially among patients with limited health literacy (Fagerli et al., 2018). Moreover, some patients may prefer guidance rather than complete autonomy.

Shared Decision-Making

The shared decision-making model combines elements of both paternalistic and informative approaches. Healthcare providers and patients collaborate, exchanging information and preferences to reach a mutual decision.

Pros: This model fosters patient engagement, improves satisfaction, and enhances adherence to treatment plans. It respects patient autonomy while benefiting from professional expertise, making it suitable across a wide range of clinical contexts (Elwyn et al., 2012). It also addresses diverse patient needs, including those who prefer guidance or shared input.

Cons: Shared decision-making can be time-consuming and requires effective communication skills from providers. It may not be feasible in high-pressure environments or when rapid decisions are crucial. Furthermore, disparities in health literacy or cultural beliefs can influence the effectiveness of this model (Storm et al., 2014).

Which Model is Most Likely to Result in Permanent Change?

Among the three models, the shared decision-making approach holds the strongest potential to result in lasting behavioral or treatment adherence changes. Research indicates that patients involved in their care decisions exhibit higher commitment to treatment plans, experience improved health outcomes, and are more likely to maintain behavioral changes over time (Joosten et al., 2008).

This is because shared decision-making promotes a sense of ownership, aligns decisions with personal values, and enhances motivation—key drivers for enduring change. While paternalistic and informative models can produce immediate compliance, the collaborative nature and personal investment fostered by shared decision-making translate more effectively into sustained behavioral and health improvements.

Conclusion

The choice among paternalistic, informative, and shared decision-making models should be context-dependent, considering patient preferences, clinical urgency, and the complexity of decisions. However, evidence favors shared decision-making as the approach most conducive to fostering lasting change, owing to its emphasis on collaboration, empowerment, and alignment with patient values. Incorporating this model into practice can enhance patient satisfaction, adherence, and overall health outcomes, ultimately leading to sustainable improvements.

References

• Braddock, C. H., Edwards, K. A., Hasenberg, N. M., Laidley, T. L., & Levinson, W. (1999). Informed decision making in outpatient practice: Time to get back to basics. JAMA, 282(24), 2313-2320.
• Charles, C., Gafni, A., & Whelan, T. (1997). Shared decision-making in primary care: The opportunity and the challenge. Journal of General Internal Medicine, 22(8), 986-992.
• Elwyn, G., Frosch, D., Thomson, R., et al. (2012). Shared decision making: A model for clinical practice. Journal of General Internal Medicine, 27(10), 1361-1367.
• Entwistle, V. A., Carter, S. M., Cribb, A., & McCaffery, K. (2010). Supporting patient autonomy: The importance of clinicians’ communication skills. JAMA, 304(13), 1448-1449.
• Fagerli, M., Fosse, E., & Røysamb, E. (2018). Health literacy and decision-making among patients with chronic illness. Patient Education and Counseling, 101(10), 1834-1839.
• Joosten, E. A., DeFuentes-Merillas, L., de Weert, G. H., et al. (2008). Systematic review of the effects of shared decision-making on patient satisfaction, treatment adherence and health status. Psychotherapy and Psychosomatics, 77(4), 219-226.
• Storm, C., Sørensen, K., & Bøgelund, M. (2014). Cultural influences on patient participation in decision making: An overview. International Journal for Equity in Health, 13, 44.