Decision Paralysis: Recognition and Patient-Centered Discourse

• Published in: Dermatology and therapy Vol. 13; no. 5; pp. 1211 - 1217
• Main Authors: Schreidah, Celine M., Fahmy, Lauren M., Lapolla, Brigit A., Geskin, Larisa J.
• Format: Journal Article
• Language: English
• Published: Cheshire Springer Healthcare 01.05.2023; Springer; Adis, Springer Healthcare
• Subjects: Care and treatment; Chronic disease; Chronic illness; Decision-making; Dermatology; Health aspects; Influence; Internal Medicine; Long-term care; Medicine; Medicine & Public Health; Oral and Maxillofacial Surgery; Patients; Physician and patient; Plastic Surgery; Practical Approach; Psychological aspects; Psychosocial oncology; Quality of Life Research; Rare disease; United States; Chronic illness; Decision-making; Skin disease; Treatment delay; Chronic disease; Second opinion; Rare disease; Psychosocial oncology; Long-term care; Shared decision-making
• ISSN: 2193-8210; 2190-9172
• DOI: 10.1007/s13555-023-00921-3

Decision paralysis (DP) can be defined as a patient’s inability to commit to a physician and/or initiate appropriate treatment for their condition. An incessant search for greater physician opinions often leads to treatment delay, disease progression, and initiation of care at more advanced stages. Despite the harms associated with DP, a dearth of research on the issue remains. There are no guidelines that assist in both recognition and rectification of DP, leaving patients with chronic illnesses and diagnoses without well-characterized treatment algorithms especially vulnerable. This paper analyzes why patients are inclined toward DP and the clinical implications. Review of the literature affirms that the patient–physician relationship holds considerable influence; physicians identifying DP can improve therapeutic outcomes for their patients. Using these findings, we then propose a framework for broaching this topic with a method that supports patients while respecting their autonomy. A practical approach to both recognition and patient-centered discourse is introduced, providing a foundation for physicians to host these conversations and understand their patients’ perspectives. This approach toward recognition and discourse on DP holds clinical importance, given that there is a paucity of established guidance. A future uniform approach may generate optimal patient care recommendations, which will hold far-reaching impact on both the patient–physician relationship and overall patient outcomes.