Box 1.

A case study of shared decision-making.

JT is a 30-year-old female who will be visiting her primary care nurse practitioner (NP) for her annual physical exam. JT has been a patient at the Family Health Center for 10 years. During this time, she has established a relationship with her NP built on mutual trust and respect. There have been many times in the past 10 years when JT has called her NP with additional questions about her care and treatment. This accessibility allows for open communication and information exchange to provide opportunities for further discussion, education, and ultimately decision making. In fact, one of the primary reasons that JT is comfortable with her NP is the give and take trusting relationship that has been established. During visits, the NP always asks JT about her own opinions and ideas about care and treatment options so they can engage in the shared decision-making process. During this annual visit, JT plans to discuss whether or not she will have genetic testing for breast cancer. JT has a strong family history of breast cancer including her cousin, grandmother, and mother. JT is also aware that her mother is positive for the breast cancer gene (BRCA) and because of this she has been struggling with the uncertainty of being tested herself. During her yearly physical, the NP assesses what JT currently knows. The NP then spends time with JT providing education about genetic testing, what it entails, and what the results may indicate including the risks, benefits, and value this additional knowledge may or may not add to future decisions. The NP offers guidance on additional sources of information that JT may access on her own to enhance her knowledge as well as any community resources that may be available. Furthermore, the NP offers additional guidance by reminding JT that she is available for additional discussion. JT takes the information offered by her NP and searches out additional genetic counselling, education, and support groups in the community. The following week JT calls the Family Health Center and requests to speak with her NP. During the follow up phone call, in an attempt to find balance, JT and the NP continue the discussion about having genetic testing and what a positive outcome would mean. The NP provides additional education about the different courses of action but reminds JT that the first decision that must be made is whether or not JT wishes to be tested given her family history. Ultimately, JT takes action and makes the decision to be tested. She notes that she already lives a life of uncertainty about whether or not she will ever be diagnosed with breast cancer. If JT tests positive she would be able to make some definitive changes in her lifestyle that could prevent breast cancer and also make critical testing decisions that could lead to early diagnosis. JT knowns she can return to her NP at any time to assist in any uncertainty that may result from this decision. JT believes that the relationship with her NP and the inviting nature of the Family Health Center fosters a patient-centered culture necessary for shared decision-making.