Table 2.
Some common challenges and prospect of deliberative democracy in health care
| Challenges |
| Lack of conceptual clarity and consistency in various understandings of deliberative democracy |
| Mitigating vested interests that may divert deliberative process |
| Instrumental use of deliberative processes for policy legitimation |
| Achieving sufficient representativeness in deliberating bodies |
| Varied public willingness and ability to participate |
| Concern with productivity and time pressure |
| Lack of concern with outcome or effectiveness of deliberations |
| Inadequate training programs in SDM for clinicians |
| Lack of financial and other incentives for the providers |
| Imbalance of resources among citizens, providers, and administrators |
| Recognition of patient values by providers in clinical practice |
| Inability to distinguish between failure of effective SDM and poor SDM technique or application |
| Disregard for public input due to political, managerial, and clinical hegemony |
| Lack of commitment to implement the decisions of citizen panels |
| Inclusion of disadvantaged and vulnerable populations in deliberative processes |
| Prospects |
| Use of experiential learning and behavioral modeling for operationalizing involvement |
| Better access to services and information for service users |
| Informative and stimulating opportunities for the public |
| Positive perceptions of health professionals regarding the effectiveness of SDM to improve care process and patient outcome |
| Use of multiple methods for engagement (broad consultation combined with in-depth deliberations) |
| Extension of environmental public participation approaches to health care |
| Application of SDM in longer-term decisions and chronic illnesses |
| SDM as a bridge between patient care and population health |
| Published evidence of likely effectiveness of patient/public engagements |
| Increasing reception of SDM by governments, research foundations, academics, and patient, professional, private, and nonprofit organizations |
| Strong public preference for engagement at systems and policy levels |
| Consideration of contextual factors along with methods of engagement |
Abbreviation: SDM, shared decision-making.