ARTICLE IN PRESS

$Sydney Health DecisionCorresponding author KE-Mail kirstenmhealth

Zarztl Fortbild Qudoi101016jzgesu

Zarztl Fortbild QualGesundhwes (ZaeFQ) 101 (2007) 205ndash211

wwwelsevierdezaefq

Schwerpunkt

Shared decision-making in Australia$Kirsten J McCaffery1 Heather L Shepherd2 Lyndal Trevena1 Ilona Juraskova23 Alexandra Barratt1Phyllis N Butow23 Karen Carey Hazell4 Martin HN Tattersall25

1School of Public Health University of Sydney NSW 2006 Australia2Medical Psychology Research Unit Blackburn Bld (DO6) University of Sydney NSW 2006 Australia3Medical Psychology Research Unit School of Psychology Brennan McCallum Bld (A18) University of Sydney NSW 2006 Australia4Former Chair Health Consumers Council of Western Australia and Member Consumer Health Forum Canberra Perth WA Australia5Department of Cancer Medicine Blackburn Bld (006) University of Sydney NSW 2006 Australia

Abstract

This paper describes the current position of shared decision-making (SDM)within the Australian health care system Australian health care includes amixture of public and private practice governed by both regional andnational policy Support for SDM exists through guidelines and support forinterventions to increase participation However there is no clear overallpolicy framework for SDM in Australia The result is recognition thatconsumer involvement is important yet there are limited resources and

Groupirsten McCaffery Tel 61 2 9351 7220 Fax 61 2 9351 5049

usydeduau (KJ McCaffery)

alGesundhwes (ZaeFQ)n200702025

infrastructure and no clear strategy to support implementation Barriers toSDM at the macro meso and micro levels of health care are describedEfforts to support consumer involvement to date have been targeted tothe supply side of health care There is now awareness of the need totarget the demand side by educating consumers to ask for informationand involvement in their health care

Key words Patient participation patient information shared decision-making health care system Australia

As supplied by publisher

Partizipative Entscheidungsfindung in Australien

Zusammenfassung

Diese Arbeit beschreibt den derzeitigen Stand der Partizipativen Entschei-dungsfindung (PEF) im australischen Gesundheitssystem Das australischeGesundheitssystem besteht aus einer Mischung von offentlichen undprivaten Gesundheitseinrichtungen die von regionaler und nationalerPolitik gefuhrt werden Unterstutzung fur PEF existiert durch Leitlinien unddurch Interventionen die Patientenbeteiligung erhohen Jedoch gibt eskeinen klaren politischen Rahmen fur PEF in Australien Daraus folgt dieErkenntnis dass die Einbeziehung von Patienten zwar wichtig ist

allerdings sind die Ressourcen und die Infrastruktur begrenzt und es gibtkeine klare Strategie die Umsetzung der PEF zu unterstutzen Es werdendie Hurden fur PEF auf Makro- Meso- und Mikroebene beschrieben Diederzeitigen Anstrengungen die Patientenbeteiligung zu unterstutzenbeziehen sich auf die Angebotsseite der Gesundheitsversorgung Mittle-rweile wurde erkannt dass die Seite der Nachfrage durch Patientenschu-lungen zur Inanspruchnahme von Information und Einbeziehung in dieGesundheitsversorgung angezielt werden sollte

Schlusselworter Patientenbeteiligung Patienteninformation Partizipative Entscheidungsfindung Gesundheitssystem Australien

Wie vom Gastherausgeber eingereicht

205

ARTICLE IN PRESS

Australia has a population of approxi-mately 20 million people living in eightStates and Territories (regions) in anarea approximately the size of WesternEurope The Australian health caresystem is directed and funded at botha national and regional level andincludes a mixture of public and privatehealth service delivery The State andTerritory governments fund a broadrange of regional health services TheCommonwealth (or Federal) govern-ment fund most medical services outof hospital and most health researchnationally The Commonwealth pro-vides non-directed funds to the Stateand Territories to administer publichospitals Both the Commonwealthand the State and Territory govern-ments variously fund community carefor aged and disabled persons Generalpractice (GP) services are provided on afee-for-service basis with an 85rebate provided through MedicareMedicare is the Commonwealth fun-ded Australian health insurance systemthat provides universal access to healthservices Private health insurance coversfees for private hospitals and selecteddoctors in public hospitals in additionto allied health services optical anddental care This paper describes thecurrent position of shared decisionmaking (SDM) within Australian healthcare system

1 Level of patientparticipation in macromeso and micro levels

The Australian Government Depart-ment of Health amp Ageing receivesadvice and recommendations from theNational Health amp Medical ResearchCouncil (NHMRC) which involves con-sumers via appointment of consumerrepresentatives to committees and con-ducting public consultations beforemaking regulatory recommendationsor issuing guidelines In 2002 theNHMRC together with the ConsumersrsquoHealth Forum of Australia (see furtherdetails below) published the Statementon Consumer and Community Partici-pation in Health and Medical Researchguidelines for consumer participation

206

at all levels and across all types ofhealth and medical research in Austra-lia [1] The statement includes someprinciples of partnership of consumersand researchers in order to shapedecisions about research priorities spe-cific research questions and design ofresearch projects in a way that recog-nises and responds to the rights of allvoices to be heardAustralia has seven national healthpriorities receiving targeted fundingasthma cardiovascular disease dia-betes cancer control injury preventionarthritis and mental health Several ofthese have programs for patient self-management The Australian Govern-ment also has an extensive consumerhealth information website calledlsquolsquoHealth Insitersquorsquo [wwwhealthinsitego-vau] whose strategic plan specificallyaims to involve consumers in the devel-opment and evaluation of the site StateHealth Departments also have policiessupporting consumer and communityinvolvement in decision-making plan-ning development and evaluation ofservices The Western Australia (WA)Department of Health and the HealthConsumersrsquo Council of WA [httpwwwhccwaglobalnetaupagespol-icy_commenthtml] have recently signeda state Consumer Participation Policythat require all levels of healthcareadministration from local public hospi-tals to Clinical Networks and decision-making committees to include at leastone consumer representativeThe Consumerrsquos Health Forum of Aus-tralia [httpwwwchforgau] is anindependent member-based non-gov-ernment organisation which is fundedby the Australian Government It nomi-nates and supports consumer represen-tation with government industry andprofessional organisations A numberof condition-specific non-governmentorganizations (NGOs) also have keyadvocacy roles and these also involveconsumers NGOs include the NationalBreast Cancer Centre Diabetes Austra-lia Cancer Australia and Cancer Coun-cils in each state Beyond Blue (mentalhealth) Arthritis Foundation andNational Heart Foundation Australiahosts the Cochrane CollaborationrsquosConsumer and Communication Group

Zarztl Fortb

2 Present state of SDMimplementation in theAustralian Health CareSystem

Shared decision-making is espoused inmany policy and strategic directiondocuments such as the NHMRC seriesof booklets on doctor-patient commu-nication Making decisions about testsand treatments Principles for bettercommunication between healthcareconsumers and healthcare profession-als httpwwwnhmrcgovaupublica-tions is a new toolkit intended to assisthealth professionals with optimisingcommunication when discussing treat-ment options with consumers On p 1it states

lsquolsquoWhenever possible people seekinghealth advice should have opportunitiesto explain and discuss their values andpreferences so that the decisionsreached can take these into accountrsquorsquo

The Australian Council for Safety andQuality in Health Care have also pro-duced a document 10 Tips for SaferHealth Care [httpwwwsafetyand-qualitygovauinternetsafetypublish-ingnsfContent10-tips] available in 15languages which aims to help peoplebe more actively involved in their ownhealthcare [2] A draft Cancer ServicesStandards Framework has also beendeveloped stating that [3]

lsquolsquoall cancer patients are involved indecisions concerning their care to theextent that they wishrsquorsquo p172

While there is apparent support forSDM in Australia implementation islimited A survey of Australian oncolo-gists found that 80 were comfortablewith SDM but only 53 reported it astheir usual approach and many statedthat they used it only with somepatients [4] (Fig 1)Brown et al [5] audited SDM in 59consultation audio-recordings of 10oncologists seeking consent to clinicaltrials Doctors only introduced theconcept of joint decision-making abouttreatment in 24 of consultations andwhere it was discussed it was rated aspoor in 75 of cases Information

ild QualGesundhwes 101 (2007) 205ndash211wwwelsevierdezaefq

ARTICLE IN PRESS

Fig 1 Australian Mammography Decision Aid Trial httpwwwhealthusydeduaushdgresourcesdecision_aidsphp

preferences were checked in 40 ofthe consultations with 66 of thesereceiving a poor rating The doctorsinvited patient questions and com-ments in 61 of the consultationshowever 70 of these were rated aspoor Uncertainty of treatment benefitwas acknowledged in 54 of consul-tations Patients were however com-monly offered the option of delayingtheir decision about trial participation(78 of consultations) Thus manyaspects of SDM were rarely observed inthis sample of oncology consultationsFocus group interviews and participantobservation methods explored nursesrsquoapproaches to working with patients tosupport patientsrsquo participation in healthcare [6] The authors noted a sharpcontrast between the ideas nursesexpressed and their actions observedin practice Nurses said they supportedconsumer participation yet observa-tional data revealed nursing practicesthat excluded active participation byconsumers In conclusion evidence forthe implementation of SDM is sparseand the few studies that have beenconducted do not support optimismabout the uptake of these ideas

3 Mechanisms andinstitutions which supportSDM in practice

Support for shared decision-making inAustralia exists through guidelines and

Zarztl Fortbild QualGesundhwes 101 (2007)wwwelsevierdezaefq

support of interventions which aim toincrease participation Three NHMRCpublications specifically promotepatient involvement in decision makingas part of optimal care [7ndash9] httpwwwnhmrcgovaupublications

The Royal Australian College of GeneralPractitioners (RACGP) document Shar-ing Health Care Chronic ConditionSelf-Management Guidelines alsoasserts that

lsquolsquoWhen treatment is jointly planned andnegotiated and information is sharedbetween doctor and patient the patientis assisted to exercise autonomy andfollow an agreed planrsquorsquo [10]

httpwwwracgporgauguidelinessharinghealthcare

These publications are complementedby a number of other consumer-ledinitiatives The Patient Charter pro-duced by the Victorian State Govern-ment states that

lsquolsquoYou should be fully involved in deci-sions about your care and be given theopportunity to ask questions and dis-cuss treatments so you understandwhat is happeningrsquorsquo

httpwwwhealthvicgovaupatient-charterpatienthtm

Tip One of The Australian Council forQuality and Safety in Health Care

205ndash211

document states lsquolsquoBe actively involvedin your own healthcarersquorsquo [2]

Pamphlets produced by consumergroups particularly in the oncologysetting promote patientsrsquo active parti-cipation in their healthcare (eg MyJourney Kit developed by Breast Can-cer Network Australia httpwwwbcnaorgau) Cancer Voices Australiaalso links advocacy groups across thecountry and aims to ensure cancerconsumers are involved in decisionmaking regarding treatment researchsupport and care throughout theircancer journey

Implementation of tools and interven-tions to increase patient participation

Decision Aids In Australia decision aids(DAs) have been developed for a num-ber of different settings

Health screening

Genetic counselling

Disease prevention

Cancer early and advanced stage

treatment decisions

Clinical trial participation

Only one DA has been implementednationally The NHMRC commissionedthe Sydney Health Decision Group(SHDG) to produce a DA for womenconsidering hormone replacementtherapy Copies were distributed toGPs across Australia and can be down-loaded from the internet [httpwwwnhmrcgovaupublications] [11](Fig 2)Question Prompt Lists (QPL) Questionprompt lists aim to aid the patient inobtaining the information she maywant by listing questions pertinent totheir situation [12ndash16] The CancerInstitute New South Wales is fundinga project to evaluate the implementa-tion of QPL for cancer patients consult-ing a surgeon radiation or medicaloncologist or a palliative care doctor inNew South Wales Palliative Care Aus-tralia has disseminated a QPL forpatients consulting a palliative caredoctor [httpwwwpallcareorgau]

207

ARTICLE IN PRESS

Fig 2 NHMRC Making Decisions Should I use hormone replacement therapy

Audio-recording consultations

The value of audio-taping has beenexplored and has proven of value inallowing patients to clarify details ofprevious consultations as well as togive further opportunity to absorb theplethora of information given in anyconsultation [1718] The Cancer Insti-tute NSW has recently funded a systemin two public hospitals in Sydney whichenables recording of the consultationand instant transfer to a CD whichpatients can take home

4 Barriers to SDM inAustralia

There is little research in Australiaidentifying barriers to implementationof a SDM approach In a systematicreview (1990ndash2006) of health profes-sionalsrsquo perceptions of barriers to SDMpractice only one of the 28 identifiedstudies was conducted in Australia[19]

System related barriers

In the recent Guide to effective parti-cipation of consumers and communi-ties in developing and disseminatinghealth information [20] the followingsystem barriers to effective consumerparticipation were identified i) theinfrastructure of organisations often

208

does not support sufficient consumerparticipation ii) organisations may lackskill and confidence in collaboratingwith consumers iii) consumers mayneed skills in presenting and advocacyiv) vulnerable groups may have littleopportunity for input v) there maybe weak links between health informa-tion developers and consumers andcommunity organizations and vi)dissemination of health informationoften occurs without consumer inputEquity transparency and good commu-nication skills relating to purpose andprocess have been identified as keystrategies in overcoming these barriers[20]The most commonly cited barrier toimplementation of a SDM approach inAustralia has been time constraintsidentified as a critical issue in nursingand general practice [6] Other repor-ted system barriers are division oflabour and difficulties in relinquishingpower [6] excessive administrativerequirements [21] lack of broad con-sultation in developing materials andpatient preferences for clinician-provi-ded advice rather than self-adminis-tered decision aids [22]A particular challenge in the implemen-tation of SDM in Australia is theequitable provision of services forpatients in rural and remote areas[23] A key issue was lsquolsquogeographicalisolation from centres of evidence-based practice limited choice of healthcare practices for referral and fewer

Zarztl Fortb

resources compared to the urbanclinical practicersquorsquoIn total many of the SDM initiativesthat have occurred have done so in theabsence of any clear overall policyframework [24] Consequently thereare gaps in specific clinical areas thatare not covered by existing guidelines[25]

Health professional barriers

The NHMRC document Communicat-ing with Patients Advice for MedicalPractitioners [8] identifies doctor-rela-ted obstacles to adequate communica-tion Research with oncologists alsoreports barriers to SDM including lackof time perception that patients mis-understand the treatmentdisease con-cerns about increasing patientrsquos anxietyand not having sufficient evidenceabout the efficacy of specific treat-ments [4]Studies indicate that the doctorsrsquo con-sultation style is an important compo-nent of the decision-making process[2627] and varies among practitionersThese findings suggest that communi-cation skills training in university med-ical curriculae would be beneficial TheOncology Education Committee of theCancer Council Australia recently laun-ched the Ideal Oncology Curriculum formedical schools Knowledge skills andattitudes of medical students at gra-duation in which communication skillsare identified as one of the core skillsand competencies in oncology that

ild QualGesundhwes 101 (2007) 205ndash211wwwelsevierdezaefq

ARTICLE IN PRESS

graduating medical students shouldpossess The Australian Medical Coun-cilrsquos Accreditation Standards for Medi-cal Schools (2002) advise that all med-ical graduates should involve patients informulating a management plan andshould be good listeners and able toprovide information in a manner thatallows patients and families to be fullyinformedCulturally diverse communities havevarying perceptions of informationexchange and decision making whichmay pose an important barrier to SDM[28ndash30] Goldstein et al [28] foundthat a Greek community in Australiapreferred a greater involvement of thefamily in decision-making and a morepaternalistic style in their doctor Astudy of Aboriginal consumers reportedthey wanted GPs to spend more time inconsultations to get to know them andto foster a relationship with the Abori-ginal community outside of the GPndashpa-tient encounter [31] In general com-munication is facilitated when thehealth professional is aware of respect-ful of and sensitive to the back-ground emotional and cultural needsof each individual patient Most doctorslack skills in this area [32]

Consumerpatient related barriers

A number of barriers have been identi-fied anxiety embarrassment or denialabout the medical condition beinginexperienced in identifying anddescribing symptoms being intimida-ted by healthcare settings being over-awed by the doctorrsquos perceived statusbeing disadvantaged by differences inlanguage and culture being confusedby the use of medical jargon beingreluctant to ask questions or beingconcerned about taking up too muchtime [8]Low literacy skills are another impor-tant barrier Data from 1996 by theAustralian Bureau of Statistics indicatethat almost half the Australian popula-tion is likely to have some or consider-able difficulty with written informationmaterials [33] There have been noattempts to develop tools or materialsto facilitate SDM with low literacygroups in Australia

Zarztl Fortbild QualGesundhwes 101 (2007)wwwelsevierdezaefq

5 Influence of patientrights on SDMimplementation

There is no national patient charter orpatient rights statement in Australiasuch as exists in the UK (NHS PatientsCharter httpwwwpfcorguknode633) and elsewhere In 1993 theNHMRC issued general guidelines formedical practitioners on providinginformation to patients (updated in2004) [7] The guidelines hold nolegislative power rather they are seento reflect the Australian common lawright of legally competent patients tomake their own decisions about med-ical treatment and their right to grantwithhold or withdraw consent beforeor during and examination or treat-ment (NHMRC 2004 p7)Mental health policy and legislation hasdemonstrated a rights-based approachto patient participation which has beenexplicitly incorporated into the MentalHealth Act (1990) and the MentalHealth Legislation Amendment Act(1997) Individual state and area basedhealth services (eg Victorian and WAState Governments (see weblinks pre-viously listed) North Coast Area HealthService NSW httpwwwncahsnsw-govausupport) and some hospitals(Royal Childrenrsquos Hospital QueenslandhttpwwwhealthqldgovauqhppcdocumentsQHPPCbookletpdf havevoluntarily established their own indivi-dual patient charters Health CareAgreements between the federal andstate governments have meant thatstates must develop and implementsystems to ensure that patients giveinformed consent However patientparticipation in decision-making is lim-ited by a serious deficiency in theunderstanding of healthcare practition-ers and administrators as to whatinformation constitutes informed con-sent how and when it should beprovided and what decision-makingsupport patients (and clinicians) require[34]Consumer activism has played animportant role in campaigning forchange in Australia [35] Groupsformed by patients of failed healthcare

205ndash211

treatments or those with specific healthconditions have raised the profile ofpatient rights [36] Identity based con-sumer groups such as Aboriginalgroups and womenrsquos groups also playan important role [3738] as have largeNGOs and national consumer organisa-tions described in Section 1

6 Present SDM-researchand research funding

Researchers and Research groups

A small number of research groups andindividuals are working in the area ofSDM or patient choice NeverthelessAustralian research has made someimportant contributions for examplein patient-doctor communication[515263940] risk communication[4142] consumer and patient prefer-ences [4344] and evidence basedpatient choice [43ndash46]

Research goals and priorities

The Australian government has articu-lated four National Research Prioritiesone of which pertains to health Withinhealth the specific research prioritiesare described as follows

A healthy start to life

Ageing well ageing productively

Preventive healthcare

Strengthening Australiarsquos social and

economic fabric

[httpwwwdestgovausectorsresearch_sectorpolicies_issues_re-viewskey_issuesnational_research_prioritiespriority_goalspromoting_and_maintaining_good_healthhtm44]

However none of these include provi-sion for a research priority relating toSDM or patient choice

Research funding

The NHMRC funded 853 grantsamounting to $500 million to com-mence in 2007 Only two specificallyaddressed patient choice Gattellariet al DESPATCH Delivering Stroke

209

ARTICLE IN PRESS

Prevention in Atrial Fibrillation assistingevidence based choice in primary care($524653) and McCaffery et al arandomized controlled trial of a bowelcancer screening decision aid for adultswith low education and literacy($229500) demonstrating a compara-tively low commitment to funding SDMresearch in Australia

7 Future perspectives ofSDM in Australia

The legal system and consumer advo-cacy groups have influenced develop-ment of various policies for the sharingof information and decision-makingbetween doctors and patients Theresult is an unsystematic approachacross Australia to the patients to beinginformed and involved in decision-making Many doctors are still unawareof the minimum legal obligation toinform patients [34] Consequentlythere is a long way to go to ensurepatients are both informed andinvolved in decisions about their healthTo date all efforts at advancing theissues of patient rights and informationhave been targeted towards the supplyside of health care encouraging clin-icians to adopt best-practice models ininforming patients and shared decision-making with mixed results In thefuture consumer groups will need totarget the demand side by educatingconsumers as to the questions to asktheir clinicians to ensure that they getsufficient information to participate indecision-making and make decisionsthat will maximize their individualhealth outcomeIn 2005 the Australian governmentestablished a new health policy initia-tive called Strengthening Cancer CareIncreased research funding for cancerwas announced as well as the estab-lishment of a new health agency calledCancer Australia Although none oftheir current research priorities expli-citly include SDM cancer patients havebeen a very powerful advocacy groupin recent years and it is possible thatthey will influence the research prio-rities of this new initiative embracing

210

shared decision making and patientchoice

Statement on conflict of interest

We hereby declare there is no conflictof interest according to the UniformRequirement for Manuscripts Submit-ted to Biomedical Journals

References[1] NHMRC (National Health and Medical

Research Council) amp Consumersrsquo HealthForum of Australia Statement on Consu-mer and Community Participation inHealth and Medical Research CanberraCommonwealth of Australia NHMRC2002

[2] ACSQHC (Australian Council for Safetyand Quality in Health Care) 10 Tips forSafer Health Care Canberra ACSQHC2003

[3] NBCC (National Breast Cancer Centre)Australian Cancer Network The CancerCouncil Australia A core strategy forcancer care Accreditation of cancer servi-ces ndash A discussion paper 2005 URL httpwwwcancerorgaudocumentsCore_Stra-tegy_Cancer_Care_Accreditation_of_Can-cer_Services_Discussion_Paperpdf lastaccessed February 2007

[4] Shepherd HL Tattersall MHN Butow PNShared treatment decision making A sur-vey of cancer doctorsrsquo views and attitudesacross Australia 32nd Annual ScientificMeeting Clinical Oncological Society ofAustralia 2005 Nov Brisbane Australia

[5] Brown RF Butow PN Ellis P Boyle FTattersall MHN Seeking informed consentto cancer clinical trials describing currentpractice Soc Sci Med 200458(12)2445ndash57

[6] Wellard S Lillibridge J Beanland C LewisM Consumer participation in acute caresettings an Australian experience Int JNurs Pract 20039(4)255ndash60

[7] NHMRC (National Health and MedicalResearch Council) General Guidelines forMedical Practitioners on Providing Informa-tion to Patients 2004 [cited Availablefrom httpwwwnhmrcgovau]

[8] NHMRC (National Health and MedicalResearch Council) Communicating withpatients advice for medical practitionersCanberra Commonwealth of AustraliaNHMRC 2004

[9] National Breast Cancer Centre andNational Cancer Control Initiative ClinicalPractice Guidelines for the PsychosocialCare of Adults with Cancer CamperdownNSW National Breast Cancer Centre2003

Zarztl Fortb

[10] Royal Australian College of General Practi-tioners Chronic Condition Self Manage-ment Guidelines 2003

[11] NHMRC (National Health Medical ResearchCouncil) Making decisions Should I usehormone replacement therapy (HRT)2005 [cited 2005 Available from httpwwwnhmrcgovaupublications_fileswh37pdf]

[12] Brown R Butow PN Boyer MJ TattersallMH Promoting patient participationin the cancer consultation evaluationof a prompt sheet and coaching in ques-tion-asking Br J Cancer 199980(1ndash2)242ndash8

[13] Brown RF Butow PN Dunn SM TattersallMH Promoting patient participation andshortening cancer consultations a rando-mised trial Br J Cancer 200185(9)1273ndash9

[14] Butow PN Dunn SM Tattersall MHN JonesQJ Patient participation in the cancerconsultation Evaluation of a questionprompt sheet Ann Oncol 19945(3)199ndash204

[15] Clayton J Butow PN Tattersall MH ChyeR Noel M Davis JM et al Asking ques-tions can help development and prelimin-ary evaluation of a question prompt list forpalliative care patients Br J Cancer 2003892069ndash77

[16] McJannett M Butow P Tattersall MHThompson JF Asking questions can helpdevelopment of a question prompt list forcancer patients seeing a surgeon Eur JCancer Prev 200312(5)397ndash405

[17] Koh THHG Butow PN Coory M Budge DCollie L-A Whitehall J et al Provision oftaped conversations with neonatologists tomothers of babies in intensive care rando-mised controlled trial Br Med J 2007334(7583)28ndash31

[18] Tattersall MH Butow PN Consultationaudio tapes an underused cancer patientinformation aid and clinical research toolLancet Oncol 20023(7)431ndash7

[19] Gravel K Legare F Graham I Barriers andfacilitators to implementing shared deci-sion-making in clinical practice a systema-tic review of health professionalsrsquo percep-tions Implement Sci 20061(1)16

[20] NHMRC (National Health and MedicalResearch Council) Guide to effective par-ticipation of consumers and communitiesin developing and disseminating healthinformation Canberra Commonwealthof Australia NHMRC 2006

[21] Bajramovic J Emmerton L Tett SE Percep-tions around concordance ndash focus groupsand semi-structured interviews conductedwith consumers pharmacists and generalpractitioners Health Expect 20047(3)221ndash34

[22] Steginga SK Pinnock C Jackson C Gian-duzzo T Shared decision-making andinformed choice for the early detection ofprostate cancer in primary care BJU Int200596(9)1209ndash10

ild QualGesundhwes 101 (2007) 205ndash211wwwelsevierdezaefq

ARTICLE IN PRESS

[23] Taylor J Wilkinson D Blue I Dollard JEvidence-based rural general practicebarriers and solutions in South AustraliaRural Remote Health 2 (online) 2002116

[24] Weller D Veale B Changing clinical prac-tice evidence-based primary care in Aus-tralia Health Soc Care Community 19997(5)324ndash32

[25] Rubin GL Frommer MS Vincent NCPhillips PA Leeder SR Getting new evi-dence into medicine Med J Aust 2000172(4)180ndash3

[26] Henman MJ Butow PN Brown RF Boyle FTattersall MH Lay constructions of decisionmaking in cancer Psychooncology 200211295ndash306

[27] Salkeld G Solomon M Short L Butow PNA matter of trust ndash patientrsquos views ondecision-making in colorectal cancerHealth Expect 2004t7(2)104ndash14

[28] Goldstein D Thewes B Butow P Commu-nicating in a multicultural society II Greekcommunity attitudes towards cancerin Australia Intern Med J 200232(7)289ndash96

[29] Huang X Butow P Meiser M Clarke SGoldstein D Communicating in a multi-cultural society the needs of Chinesecancer patients in Australia Aust N Z JMed 199929207ndash13

[30] Yeo SS Meiser B Barlow-Stewart K Gold-stein D Tucker K Eisenbruch M Under-standing community beliefs of Chinese-Australians about cancer initial insightsusing an ethnographic approach Psy-chooncology 200514(3)174ndash86

Zertifizierter PatientenratgeberrsquorsquoUmg

In psychischen Krisen sind Medikamentemanchmal unverzichtbar Das Ratgeberbuch

rsquorsquoUmgang mit Psychopharmaka

rsquorsquo

stellt alle Psy-chopharmaka auf dem deutschsprachigenMarkt vor erklart die Funktionsweisen samtWirkung und Nebenwirkung und gibt Hinwei-se zum Reduzieren und AbsetzenDie Stiftung Gesundheit hat das Buch zertifi-ziert Die Gutachter bewerten das Werk

rsquorsquoals

einen sehr informativen leicht verstandlichenund optimal aufgeteilten Ratgeber welchereinen umfassenden Uberblick der medika-

Zarztl Fortbild QualGesundhwes 101 (2007)wwwelsevierdezaefq

[31] Andrews B Simmons P Long I Wilson RIdentifying and overcoming the barriers toAboriginal access to general practitionerservices in Rural New South Wales Aust JRural Health 200210(4)196ndash201

[32] Butow P Tattersall M Shared decisionmaking in cancer care Clin Psychol 20059(2)54ndash8

[33] NHMRC (National Health and MedicalResearch Council) How to prepare andpresent evidence-based information forconsumers of health services a literaturereview Canberra Commonwealth of Aus-tralia NHMRC 2000

[34] Skene L Millwood S Informed consent tomedical procedures the current law inAustralia Doctorsrsquo knowledge of the lawand their practices in informing patientsCanberra Social Science Press 1997

[35] Bastian H Speaking up for ourselves TheEvolution of Consumer Advocacy in HealthCare Int J Technol Assess Health Care199814(1)3ndash23

[36] Bromberg B Fife-Yeomans J Deep sleepHarry Bailey and the scandal of Chelms-ford Sydney Simon and Schuster 1991

[37] Broom DH Dammed if we do contra-dictions in womenrsquos health care SydneyAllen and Unwin 1991

[38] National Aboriginal Health Strategy Work-ing Party A National Aboriginal HealthStrategy Canberra Department of Abori-ginal Affairs 1989

[39] Hagerty RG Butow PN Ellis PM Dimitry STattersall MHN Communicating prognosisin cancer care a systematic review of theliterature Ann Oncol 200516(7)1005ndash53

ang mit Psychopharmaka

rsquorsquo

mentosen und nicht-medikamentosen Be-handlungsmoglichkeiten psychischer Erkran-kungen liefert

rsquorsquo

Das Autorenteam mochte Patienten dazu er-mutigen sich eine eigene Meinung zu bildensowie ihre Wunsche und Ziele in das Ges-prach mit dem Arzt einzubringen und mitihm gemeinsam zu

rsquorsquoverhandeln

rsquorsquo

welche Be-handlung der beste Weg ist

rsquorsquoUmgang mit Psychopharmaka

rsquorsquo

Nils GeveMargret Osterfeld Barbara Diekmann BA-LANCEratgeber Psychiatrie Verlag ISBN 978-

205ndash211

[40] Trevena LJ Barratt A Butow P Caldwell PA systematic review on communicatingwith patients about evidence J Eval ClinPract 200612(1)13ndash23

[41] Lobb EA Butow P Barratt A Meiser BTucker K Differences in Individual Approa-ches Communication in the Familial BreastCancer Consultation and the Effect onPatient Outcomes J Genet Couns 200514(1)43

[42] Lobb EA Butow PN Barratt A Meiser BGaff C Young MA et al Communicationand information-giving in high-risk breastcancer consultations influence on patientoutcomes The Br J Cancer 200490(2)321

[43] Barratt A Trevena L Davey HM McCafferyK Use of decision aids to support informedchoices about screening Br Med J 2004329(7464)507ndash10

[44] Barratt A Howard K Irwig L Salkeld GHoussami N Model of outcomes of screen-ing mammography information to sup-port informed choices Br Med J 2005330(7497)936

[45] Gattellari M Ward JE Does evidence-based information about screening forprostate cancer enhance consumer deci-sion-making A randomised controlledtrial J Med Screen 200310(1)27ndash39

[46] Nagle C Lewis S Meiser B Metcalfe SCarlin J Bell R et al Evaluation of adecision aid for prenatal testing of fetalabnormalities a cluster randomised trial[ISRCTN22532458] BMC Public Health20066(1)96

3-86739-002-6 fur 1490 Euro im Buchhan-del erhaltlich

KorrespondenzadresseStiftung GesundheitBehringstraszlige 28 a22765 HamburgTel 040 80 90 87 - 0Fax 040 80 90 87 - 555E-Mail sgarztmaildewwwstiftung-gesundheitde

Literatur und Rezensionen

211