Z. Evid. Fortbild. Qual. Gesundh.

wesen (ZEFQ) 123-124 (2017) 12–16

Contents lists available at ScienceDirect

Z. Evid. Fortbild. Qual. Gesundh. wesen (ZEFQ)

journal homepage: http://www.elsevier.com/locate/zefq

Special Issue / Schwerpunkt

Shared decision making in Argentina in 2017

Partizipative Entscheidungsfindung in Argentinien im Jahr 2017
Mariela Barani 1,∗ , Karin Kopitowski 1,2 , Carolina Carrara 1 , María Victoria Ruiz Yanzi 1
1
Department of Family and Community Medicine, Hospital Italiano de Buenos Aires, Argentina
2
Research Department, IUHI, Hospital Italiano de Buenos Aires, Argentina

a r t i c l e i n f o a b s t r a c t

Article History: Argentina is a high-middle income country located in Southern South America with an estimated popula-
Available online: 22 May 2017 tion of 44 million inhabitants. The epidemiological profile of the population is characterised by an increase
of non-communicable diseases. The health system is heterogeneous, fragmented and loosely integrated.
Keywords: There are no unified research agenda or government initiatives encouraging the implementation of and
shared decision making research on shared decision making (SDM). Progress has been made lately to respect patient autonomy
patient involvement through the enactment of the ‘Patients’ Rights Act’, which expressly enshrines the right of patients to get
patients’ rights information as a key element of decision-making.
implementation To our knowledge, the team at the Department of Family and Community Medicine of the Hospital
Argentina Italiano de Buenos Aires is the only one working on shared decision making in Argentina. This department
carries out research, medical undergraduate and graduate training, and clinical practice implementation
activities through strategies aimed at professionals and patients alike.
We face some challenges regarding SDM, such as: 1) the fragmentation and the heterogeneity of the
local health system; 2) we are a small group of people working on this topic who, simultaneously, have
care, management, teaching and research responsibilities; 3) we have no government support and project
funding is scarce; 4) due to the geographic location of the country, we must make a great effort in order
to attend events on the state of the art in SDM.
Given the current state of our health system, we believe the government is not likely to encourage,
implement or research on SDM in the short term. Our group will continue to work on the local initiative
and also to instil it in other interested groups.

a r t i k e l i n f o z u s a m m e n f a s s u n g

Artikel-Historie: Argentinien mit geschätzt 44 Millionen Einwohnern liegt im Süden Südamerikas und gehört zu den
Online gestellt: 22. Mai 2017 Ländern mit mittleren bis hohen Einkommen. Was die Gesundheit der Bevölkerung betrifft, so zeich-
net sich das epidemiologische Profil durch einen Anstieg nichtübertragbarer Erkrankungen aus. Das
Schlüsselwörter: Gesundheitssystem ist heterogen, fragmentiert und nur lose integriert. Es gibt weder eine einheitliche
partizipative Entscheidungsfindung Forschungsagenda noch staatliche Initiativen zur Förderung der Implementierung von partizipativer
Patientenbeteiligung Entscheidungsfindung und diesbezüglicher Forschung. Durch das Inkrafttreten des Patientenrechtege-
Patientenrechte setzes (‘‘Ley de derechos de los pacientes‘‘) wurden in jüngster Zeit deutliche Fortschritte im Hinblick auf
Implementierung die Achtung der Patientenautonomie erzielt. In diesem Gesetz ist das Recht der Patienten auf Information
Argentinien und Aufklärung als Schlüsselelement der Entscheidungsfindung ausdrücklich verankert worden.
Nach unserem Wissensstand ist die Abteilung für Allgemein- und Familienmedizin am Hospital
Italiano de Buenos Aires die einzige in Argentinien, an der partizipative Entscheidungsfindung (PEF) derzeit
thematisiert wird. Diese Abteilung forscht, bildet Studierende der Medizin im Grund- und Hauptstudium
aus und widmet sich der Implementierung von PEF in der klinischen Praxis unter Einsatz von Strategien,
die gleichermaßen auf Fachkräfte wie auch Patienten abzielen.

∗ Corresponding author: Mariela Barani, Department of Family and Community Medicine, Hospital Italiano de Buenos Aires, Argentina.
E-mail: marielabarani@gmail.com (M. Barani).

http://dx.doi.org/10.1016/j.zefq.2017.05.003
1865-9217/
 M. Barani et al. / Z. Evid. Fortbild. Qual. Gesundh. wesen (ZEFQ) 123-124 (2017) 12–16 13

Bei der Implementierung von partizipativer Entscheidungsfindung begegnen wir verschiedenen Heraus-
forderungen: 1) der Fragmentierung und Heterogenität im örtlichen Gesundheitswesen; 2) dem Umstand,
dass das Team, das sich mit diesem Thema befasst, nur aus wenigen Mitgliedern besteht, die gleichzeitig
in der medizinischen Versorgung, im Management sowie in Lehre & Forschung tätig sind; 3) dass wir von
Regierungsseite keine Unterstützung erhalten und dass die Mittel zur Finanzierung von Projekten knapp
sind; 4) dass die Teilnahme an Veranstaltungen zum aktuellen Stand der partizipativen Entscheidungs-
findung aufgrund der geografischen Lage unseres Landes mit großen Aufwand verbunden ist.
Angesichts des aktuellen Zustands des Gesundheitswesens in unserem Land halten wir es für eher
unwahrscheinlich, dass die Regierung die Umsetzung von partizipativer Entscheidungsfindung oder
Forschung auf diesem Gebiet in naher Zukunft fördern wird. Unsere Gruppe wird diese lokale Initiative
weiter fortführen, auch mit dem Ziel, andere interessierte Gruppen anzusprechen.

Background of the health system
The Argentine Republic is an upper-middle income country
[1] located in Southern South America. It is divided into 23
provinces and an autonomous city (Autonomous City of Buenos
Aires) for administration purposes, with big socio-economic dif-
ferences among them. By 2010 Argentina had a population of 40.1
million inhabitants [2] (49% male and 51% female). The estimated
population in 2017 is approximately 44 million people [3]. Around
92% of the population lives in urban areas and one third lives in
the metropolitan area of Buenos Aires, which also accounts for 40%
of the GDP (gross domestic product). Regarding the structure of
the population, the population is visibly ageing. The ratio of elderly
people went from 2.5% in 1895 to 3.9% in 1947 and 10% in 2010.
The health of Argentines has improved considerably in the
past twenty years as they now live longer and better. The epi-
demiological profile is characterised by a growing prevalence of
non-communicable diseases [4]. However, there is a huge gap
among the provinces. If we take, for instance, maternal mortality,
while its rate in the City of Buenos Aires in 2015 was lower than 2
per 10,000 live births, in the northern provinces of the country the
rate was somewhere between 10 and 15, according to the province
[5]. Similarly, in the areas with a higher per-capita income, child
mortality is 6.4 per 1,000 live births, while it is 12.4 in the poorest
provinces [6].
Healthcare in Argentina has very unique features, so it is difficult
to talk of a single health system. Multiple health financing systems
—loosely integrated and internally fragmented— coexist, compete
and overlap in Argentina: the public sector, the compulsory social
security sector (obras sociales or union health insurance providers)
and the private sector [7,8].
The public sector comprises the provincial and national admin-
istrative structures at the ministry level and the network of public
hospitals and healthcare centres that provide free care to any per-
son that requires so (usually people without social security who
have no means), and is financed through tax revenues. The compul-
sory social security sector is structured around three types of social
security institutions: 1) the national obras sociales, around 270
institutions organised by economic sector, managed by the work-
ers’ unions and coordinated by a national agency (Health Services
Superintendence); 2) the provincial obras sociales, 24 institutions
providing health insurance to the civil servants of each province;
and 3) the Comprehensive Medical Care Plan of the National Insti-
tute of Social Services for Retirees and Pensioners, which provides
coverage to retirees from the national welfare system and their
families.
The private sector includes: a) professionals providing indepen-
dent services to private patients insured by specific union health
insurance providers or private health insurance systems; b) health-
care facilities, also hired by the union health insurance providers;
and c) voluntary health insurance companies called private health
insurance providers. Approximately 6% of the population has
healthcare coverage through individual contributions to one of the
150 private health insurance providers.
The social security system can be described as broad in terms of
coverage and segmented in terms of the number of funds involved,
with increasing transfer of risk to the providers, in a clear separation
between insurance functions and delivery functions. Legislation
passed in recent years moves towards a system with greater con-
centration of funds, and mainstreaming of a mandatory medical
plan financed through cross-subsidising among people with differ-
ent incomes and risks. However, the employment crisis reduces the
total financing sources of the system, which impacts the funding of
the provider model.
Legislative efforts to get shared decision making
implemented in the Argentine health system
Medical practice has suffered dramatic changes in past decades
due to several factors: the advancement of technology, the enact-
ment of laws enshrining the right to health, and the proliferation of
patients’ rights, among others. The doctor-patient-family relation-
ship is based on the paternalistic model, but is currently adapting to
the paradigm shift as reflected in the national legislation. The prin-
ciple of free will has been legally reflected by the right to personal
self-determination. In light thereof, the protection of the human
right to health needs to be enshrined in laws enabling the adop-
tion of healthcare-related informative and documentary measures.
The importance of patients’ rights in this context, as the pivotal
element of medical relationships, has been made clear by interna-
tional organisations like the World Health Organisation, the United
Nations, the European Union, and the Council of Europe, among
others. They have adopted declarations and passed legislation and
protocols in that regard.
Law 26.529, better known as the ’Patients’ Rights Act’, is in force
in Argentina; it is a first step —necessary and meaningful— towards
the protection and enforcement of the right to health [9]. This law
expressly provides for the patients’ right to receive information as a
key element in decision-making, especially at times like the present
when patients are leaving behind the role of passive subjects in the
doctor-patient relationship and becoming the lead when it comes
to deciding on their own bodies. The enactment of this law allows
for behaviours so far governed almost exclusively by ethical rules
to become enforceable, but there are as well individual and other
behaviours of interest to the society that require regulation in order
to prevent the excessive court action of late. In the future, upon
a conflict of opinions or values between the healthcare team and
the patient regarding the performance —or not—of a given proce-
dure, precedence shall be given to the patient’s will and decision as
patients are free and autonomous beings.
From an information standpoint, patients lack technical and
scientific knowledge about their condition, the diagnostic or ther-
apeutic procedures at hand, the risks and benefits involved, the
14 M. Barani et al. / Z. Evid. Fortbild. Qual. Gesundh. wesen (ZEFQ) 123-124 (2017) 12–16
options available and the consequences of no treatment. This
knowledge gap can be a hurdle that must be overcome by translat-
ing the necessary information into simple language, thus enabling
health services users to decide what is best for their body and con-
science. For many years, medical decisions have been made by the
healthcare team on behalf of the patients but, with the advent of the
information age and the globalisation of knowledge, a new social
order has been established where citizens know and demand every
right they have. In this way, the existence of personal autonomy is
being slowly and gradually accepted, thus determining the possi-
bility of choosing your own self-referential goals in life, which is a
right for all citizens and not charity —in bioethical terms— by the
members of the healthcare team.
This information and decision-making process is called
informed consent and is clearly defined by law: ‘Sufficient decla-
ration of will as made by the patient, or their legal representatives,
as they case may be, after receiving from the attending health-
care professional clear, accurate and adequate information relating
to: 1) their health condition; 2) the recommended procedure and
its goals; 3) the expected procedure benefits; 4) the foreseeable
risks, discomforts and adverse reactions; 5) the specification of
alternative procedures and their risks, pros and cons versus the
recommended procedure.’
One of the most salient points of the law is the regulation, at
the national level, of advance directives. These are acts of self-
protection whereby the right to free will is enforced and their object
is to protect our right to choose or reject a medical treatment.
Scientific, technological and pharmacological breakthroughs and
advances have led to prolonging life and curing diseases in ways
never imagined in the past, but their use sometimes becomes inap-
propriate when the sole goal is delaying a foreseeable fatal event:
death. This results in a distortion of the medical goal, which is not
prolonging life indefinitely, but promoting health and quality of
life and, where appropriate, restoring health when there is disease.
This law was passed in 2009 and amended in 2012 by a law known
as the Death with Dignity Act, which specifies the advance direc-
tive procedure and the rights of terminal patients in more detail.
We can conclude that since 2009 Argentina has a Patients’ Rights Act
that is in tune with the implementation of shared decision-making.
Nevertheless, the existence of this law is necessary, but absolutely
not enough to secure the lead role of the patients when it comes to
making decisions on their health.
Research and development of SDM
There is no direct support from government agencies or policies
encouraging research on SDM in Argentina.
The Department of Family and Community Medicine of the Hos-
pital Italiano de Buenos Aires (SMFyC) is the only healthcare group
that is currently conducting research on SDM and its implemen-
tation in clinical practice. Research on SDM takes priority and is
strongly encouraged on our group’s research agenda.
The SMFyC has carried out several research projects related
to SDM measurement, including the adaptation and validation of
instruments such as the OPTION scale [10], the translation, adapta-
tion, and validation of the CollaboRATE measure [11] and the ‘Ask
3 questions’ survey [12]. Such award-winning projects were pre-
sented in national and international congresses and are about to be
published.
These projects are funded mostly by the SMFyC or through
grants from the Hospital Italiano de Buenos Aires. There are
some national subsidies, such as the one from the National Cancer
Institute [13], that have been used to finance research projects
on directly-related topics, although not specifically conceived to
encourage research on SDM. It is hard for us to apply for interna-
tional grants because they are not typically meant to fund projects
in upper-middle income countries.
There are big differences among the Argentine population: cul-
tural, socio-economic and educational differences. So far, most of
the research has focused on a middle-class population (due to
access and proximity issues), like most research on SDM world-
wide. Our goal is to conduct research with socio-economically and
educationally disadvantaged social sectors, so as to develop knowl-
edge of populations with said characteristics, predominant in our
country, and who could also benefit from SDM.
It is worth noting some of the challenges we face when conduct-
ing research: 1) the fragmentation and the heterogeneity of our
health system; 2) we are a small group of people working on this
topic who, at the same time, have care, management and teaching
responsibilities, so our dedication to research is part-time; 3) we
have no government support and project funding is scarce; 4) due
to the geographic location of the country (Southern South America)
and its economic situation, we must make a great effort in order to
attend events on the state of the art in SDM.
Clinical practice guidelines, decision aids and SDM
Creation of clinical practice guidelines in Argentina is a mess.
There are very few guidelines produced by the National Health
Ministry [14]. Every scientific association, even every healthcare
facility, issues their own guidelines that are far from meeting the
AGREE standards for clinical practice guidelines.
To our knowledge, there are no guidelines including tools to
favour SDM or instruments that help healthcare providers and
their patients to discuss their preferences. It is well known that
the space provided in the guidelines for evidence and recom-
mendations vastly exceeds the space provided for instruments for
person-centred decision-making.
Our working group has not developed any new tools, but
adopted existing ones instead (see paragraph below). We hope
different sectors work together in the future in order to have acces-
sible, good quality tools produced in Spanish in accordance with the
IPDAS criteria.
Specific terminology and decision tools in Spanish
‘Shared decision-making’ is the English term used to refer to
the collaborative process that takes place between patients and
healthcare professionals for the purpose of making health decisions
weighing the best available evidence and the people’s preferences
and values. The term used in Spanish is ‘toma de decisiones compar-
tidas’ [shared decision-making] and, although easy to understand
from a language perspective, it often requires explaining who the
people who share the decisions are. As Argentina is dominated
by a paternalistic doctor-patient relationship, people wait for the
healthcare provider to tell them by the end of the visit the course
of action to be followed. It is unnatural for the patients to think
they can make health decisions together with their doctor for it is
the doctor who has the knowledge. Similarly, for most doctors it is
also unnatural to think that patients may directly get involved in
the decision to be made regarding the most appropriate screening,
diagnostic or treatment plan.
The term ‘patient-centred care’ and its Spanish translation
‘cuidados centrados en la persona’ [person-centred care] has become
popular in recent years as healthcare organisations completed
international accreditation programmes in quality and patient
safety. As part of such programmes, certain standards regarding
patients and family rights must be met. In practice, ‘person-centred
care’ is far from being understood as empowering the patients to
 M. Barani et al. / Z. Evid. Fortbild. Qual. Gesundh. wesen (ZEFQ) 123-124 (2017) 12–16
adopt an active role in looking after their health and share the
power in the relationship with the physician.
Considering that the official language of Argentina is Spanish,
the lack of validated decision aids in said language constitutes a
big hurdle in the implementation of SDM. Most aids are written in
English and very few have a Spanish version available, but, in our
opinion, their translation is really bad. There is a smaller number of
aids in proper, intelligible Spanish though but, unfortunately, not
in the variety that is spoken in Argentina. Our working group has
adopted in its clinical practice the decision aids in proper Spanish
(like the Statin Choice Decision Aid of the Mayo Clinic [15]) and is
currently working in the creation of Spanish versions of other tools
that are only available in English (Option Grids decision aids: Sore
throat: antibiotics or not? [16], Colorectal Cancer: Which Screening
Test Should I have? [17]) that would conform to the local flavour.
In some cases, it is possible for physicians with knowledge of the
English language to directly use decision aids in English, especially
when the aids are meant to be used with the patient in the office
or when the patient speaks English too.
SDM in medical education
SDM is neither included in the mandatory undergraduate
curriculum nor as an elective course in Argentine medical schools.
At the Instituto Universitario del Hospital Italiano de Buenos Aires
(IUHI) —private medical school affiliated with the Hospital Italiano
de Buenos Aires—, students are introduced to SDM and PCC by
means of theoretical discussions and practical cases in the course
Family Medicine.
The SMFyC together with the IUHI give postgraduate courses to
the medical community in general on outpatient and family health-
related issues, including training in SDM (theoretical discussion and
role playing of practical cases in a three hours session).
Besides, in said courses, all the contents are analysed from the
perspective of SDM and PCC, regardless of whether a screening,
statin or aspirin use to reduce cardiovascular risk, treatment goals
in diabetic or hypertensive patients, etc. is being discussed.
As part of their postgraduate education, resident physicians
with the SMFyC engage in the continuing education activities for
the department’s physicians described below, during the four years
of their residency.
SDM implementation
The strategy of SDM implementation in the clinical practice
within the SMFyC is mainly aimed at the healthcare profession-
als, but we have also developed strategies aimed at empowering
the patients.
Implementation strategies aimed at the professionals
Different educational activities are carried out weekly within
the SMFyC for all their physicians: grand rounds, journal clubs and
discussion groups. Shared decision-making is approached in every
activity from a cross-sectional perspective with the help of a SDM
leader, a member of the SDM team working within the Depart-
ment. Specific SDM workshops are organised regularly in order to
develop basic and advanced skills through theoretical and practical
contents.
As for science communication outside the department, an article
on this topic has been published in the hospital’s journal [18]. We
have also written a chapter in the book Medicina Familiar y Práctica
Ambulatoria [19]. The latter is a reference text for general and family
medicine for the Spanish-speaking audience.
15
Furthermore, we actively engage in congresses organised by
scientific and medical associations of family medicine, general
medicine, internal medicine and gynaecology through lec-
tures/symposia and workshops to discuss SDM topics.
Patient-mediated implementation strategies and patient
empowerment
As part of the plan to promote shared decision making, we have
made a video [20] specially aimed at patients for the purpose of
promoting their involvement in decisions concerning their health.
The video explains the concept of SDM in a simple way and encour-
ages patient involvement through three simple questions meant to
start the dialogue between doctors and patients during the medical
visit.
This is the first video in Spanish for that purpose and is one
of the videos broadcast in all the waiting rooms in the hospital. It
serves as the kick-off of all activities directly aimed at the patients
to promote SDM within the organisation.
We have also written an article to that end for a hospital publi-
cation that is distributed among all hospital patients [21].
Performance indicators in quality management plans
A quality improvement plan has been in place at the SMFyC since
2005. It encourages physicians to take part in teaching and con-
tinuing education activities, and also promotes family medicine
exemplary practices and continuity of care. Initially, it focused
mainly on quality and clinical effectiveness indicators, and encour-
aged the use of traditional indicators such as the mammography
rate in the recommended population or the HbA1c testing rate
in diabetics. Such disease-specific indicators have been gradually
replaced as they favour action and disregard patient preferences
and values —although many of them are ‘evidence-based’, evidence
turns into ‘tyranny’ if what matters to the patient is not taken into
account.
Upon implementing the SDM plan, we decided to assess the
baseline situation and measure how much physicians got the
patients involved in medical decisions in our department’s outpa-
tient offices, from both the healthcare providers’ and the patients’
perspectives using the OPTION scale and the ColaboRATE. Based on
this assessment, we intend to manage opportunities for improve-
ment in this area. At the moment, none of the indicators are
promoted within the quality plan and they are not part of the per-
formance assessment of our physicians either. We are resolved to
finding metrics that would allow us to faithfully monitor the inter-
action with patients within the setting of the medical visit so as to
apply them to the entire medical team.
Given the current state of the health system in Argentina, we
believe the government is not likely to encourage, implement or
research on SDM in the short term. All progress in the area is going
to be carried out by independent groups interested in working on
the field. We wish key issues such as PCC and SDM to be taken into
account in the development of public policies.
Conflict of Interest
The authors declare that there is no conflict of interest.
References
[1] World Bank Data Help Desk, World Bank Country and Lending Groups.
https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-
bank-country-and-lending-groups. (accessed 20.03.17).
[2] Instituto Geográfico Nacional, División Política, Superficie y Población.
http://www.ign.gob.ar/NuestrasActividades/Geografia/DatosArgentina/
DivisionPolitica. (accessed 24.03.17).
16 M. Barani et al. / Z. Evid. Fortbild. Qual. Gesundh. wesen (ZEFQ) 123-124 (2017) 12–16
[3] Instituto Nacional de Estadísticas y Censos , Proyecciones provin-
ciales de población por sexo y grupo de edad 2010-2040.
http://www.santafe.gov.ar/index.php/web/content/download/215324/
1117185/file/proyecciones prov 2010 2040.pdf. (accessed 20.03.17).
[4] Belló M, Becerril-Montekio VM. Sistema de salud de Argentina. Salud Pública
Mex 2011;53(suppl 2):S96–108.
[5] Dirección de Estadísticas e Información en Salud , Natalidad y Mortali-
dad 2014 - Síntesis Estadística 1. http://www.deis.msal.gov.ar/wp-content/
uploads/2016/05/Sintesis-estadistica-Nro1.pdf, 2016.(accessed 24.03.17).
[6] Dirección de estadísticas e información de Salud - Ministerio de salud
de la Nación , Natalidad, Mortalidad General, Infantil y Materna por
Lugar de Residencia. http://www.deis.msal.gov.ar/wp-content/uploads/
2016/03/Boletin151.pdf, 2015. (accessed 24.03.17).
[7] Centro de Estudios de Estado y Sociedad , Serie de seminarios salud y
política pública. http://imgbiblio.vaneduc.edu.ar/fulltext/files/TC048347.pdf,
2003. (accessed 20.03.17).
[8] García C. La atención de la salud en Argentina: Al gran pueblo argentino . . .
¿Salud? - Primera entrega. Evid Act Pract Ambul 2016;19:2–4.
[9] Sistema Argentino de Información Jurídica, Decreto reglamentario de
la ley 26529 sobre derechos del paciente en su relación con los profesion-
ales e instituciones de la salud. http://www.saij.gob.ar/1089-nacional-decreto-
reglamentario-ley-26529-sobre-derechos-paciente-su-relacion-profesionales-
instituciones-salud-dn20120001089-2012-07-05/123456789-0abc-980-
1000-2102soterced, 2012. (accessed 21.03.17).
[10] Observer OPTION Instrument, Homepage. http://www.optioninstrument.org/.
(accessed 21.03.17).
[11] CollaboRATE, Homepage. http://www.collaboratescore.org/. (accessed
23.03.17).
[12] Person-centred care resource centre, Testing and refining the ‘‘Ask 3 Ques-
tions’’ campaign promoting shared decision making to patients in Newcastle.
http://personcentredcare.health.org.uk/resources/testing-and-refining-%E2%
80%98ask-3-questions%E2%80%99-campaign-promoting-shared-decision-
making-patients, 2012. (accessed 24.03.17).
[13] Instituto Nacional del Cáncer, Becas de Investigación en Cáncer 2017.
http://www.msal.gov.ar/inc/destacados/becas-de-investigacion-en-cancer-
2017/. (accessed 21.03.17).
[14] Ministerio de Salud de la Nación, Guías de práctica clínica. http://www.
msal.gob.ar/ent/index.php/informacion-equipos-de-salud/guias-de-practica-
clinica. (accessed 18.04.17).
[15] Mayo Clinic, Statin Choice Decision Aid. https://statindecisionaid.mayoclinic.
org/index.php/site/index?lang=es es&PHPSESSID=4602ei5v711s12cdqf3
dcjdqg7. (accessed 23.03.17).
[16] Option GridTM decision aids, Option GridTM decision aid: Sore throat: antibi-
otics or not? http://optiongrid.org/option-grids/grid-landing/46. (accessed
23.03.17).
[17] HealthwiseR, Colorectal cancer: Which screening test should I have?
https://www.healthwise.net/cochranedecisionaid/Content/StdDocument.
aspx?DOCHWID=aa69121. (accessed 23.03.17).
[18] Barani M, Kopitowski K. Toma de decisiones compartidas: centrando los
cuidados médicos realmente en nuestros pacientes. Rev. Hosp. Ital. B. Aires
2013;33:60–4.
[19] Barani M, Kopitowski K, Decisiones compartidas: la importancia de centrar
los cuidados médicos en nuestros pacientes, in: Karin Kopitowski. . . [et Al.]
Servicio de Medicina Familiar y Comunitaria Del Hospital Italiano de Buenos
Aires, Medicina Familiar Y Práctica Ambulatoria 3a Ed., Médica Panamericana,
Ciudad Autónoma de Buenos Aires, 2016, pp. 98-105.
[20] Youtube, Toma de decisiones compartidas - Hospital Italiano de Buenos Aires.
https://www.youtube.com/watch?v=K4n0hSyuxFA. (accessed 25.03.17).
[21] Barani M, Kopitowski K. Toma de decisiones compartidas: Abriendo el juego,
Aprender Salud. Nro 2014;4:5–6.