Services
Company
Legal and Governance
Insights / Articles
Shared Decision-Making in Healthcare
Written on Tuesday, June 18, 2024
Shared decision-making has the potential to change the way medicine is practiced
In the past, clinical consensus about the safety and effectiveness of treatments guided medical decisions. It is a passive approach that a growing number of patients and clinicians have abandoned in favor of shared decision-making (SDM).
This type of decision-making prioritizes greater communication and consensus between patients and providers when establishing care plans. It is trending upward, with some data showing that 71% of patients prefer a shared or patient-led decision-making approach.
Taking a more collaborative approach to healthcare decisions has been linked to higher patient satisfaction and improved health outcomes. The shared decision making model is hailed as an antidote to medical paternalism, an important expression of patient-centered care, and a means of promoting high-value care.
“Shared decision-making is very much about collaboration, focusing on empowering and activating patients to have informed discussions with their doctors and feeling part of the decision flow,” says Sumira Riaz, health psychologist and patient engagement lead at OPEN Health.
Understanding shared decision-making
Although shared decision-making tools have become a popular healthcare topic, the concept is not new. The term was coined in 1972 as a result of growing evidence that outcomes were better when doctors and patients agreed on the problem and solution together.
“It’s innovative … but it’s also based on very old science, and the science behind it should not be forgotten,” says Marco Boeri, director of patient preference at OPEN Health.
Frameworks have been developed to describe how SDM should be carried out. These models highlight ethics of shared decision-making and encourage clinicians to seek patient participation, help explore and compare treatment options, assess patient values and preferences, arrive at a consensus about treatment, and evaluate the decisions. The U.S. Preventive Services Task Force has noted: “Having informed and involved patients is a core value in healthcare.”
Researchers have identified several essential components of an effective shared decision-making process: learn about the patient, create choice awareness, tailor information, understand patient preferences and make decisions. The process requires several steps, including fostering conversations, problem-solving, advocating for care, evaluating beyond outcomes, and seeking joint improvement to ensure that healthcare decisions are based on balanced, well-informed choices free of misunderstandings and misconceptions.
“There’s been a shift to taking a more patient-centric approach versus the (healthcare provider)-centric approach,” Riaz says. “There is more acknowledgment that patients can really drive the decisions as well.”
Moving the needle
SDM has the potential to change the way medicine is practiced, by shifting the power and control of interactions between clinicians and patients and encouraging improved collaboration and co-operation from all stakeholders. Moving the needle on shared decision making in healthcare will take some effort.
Importance of shared decision making in healthcare
The benefits of SDM is clear: It provides meaningful interactions between patients and clinicians, helps clinicians share evidence for healthcare decisions, enhances the commitment to treatment and sets realistic expectations about outcomes.
Educating and training HCPs to maximize this model of interactions
Although the focus on implementing SDM has intensified as a result of novel funding mechanisms, the establishment of patient advisory boards at public and research institutions, introduction of SDM into medical school curricula and training programs for healthcare providers, more work is needed.
Reality vs theory
Transitioning to SDM in clinical practice presents challenges. Time constraints can make it difficult to listen closely to patients, address concerns, present options, respond to questions and arrive at well-informed decisions; nearly 30 percent of physicians spend as little as 13 minutes with a patient.
Research has identified the need for more decision support tools in routine care. These tools should readable, understandable and in formats that can be taken home to share and consider in the shared decision-making process because, Riaz explains, patients might lack the health literacy needed to make informed decisions. Clinicians, she adds, must be flexible to patient needs.
“[Clinicians] should avoid being rigid … and avoid setting expectations too high; there is an element of that balance,” Riaz says. “It’s being able to have those discussions as a partner versus in a hierarchy.”
Encouraging collaboration and consensus in healthcare shared decision-making
Strong patient education with patient-centric tools and decision aids is essential for SDM.
Stakeholders — including healthcare systems, pharmaceutical companies, and healthcare providers — should collaborate to create effective, evidence-based patient decision aids that inform patients of their options and help them to make informed, deliberate choices about their healthcare options.
Shared decision-making tools can be as simple as brochures and as complex as apps that require patient input, Boeri adds. The right patient-centric materials “provide evidence-based information to both clinicians and patients and put everybody in the driving seat,” he says.
“Collaborate as much as you can, and be transparent in your interactions and communications,” Riaz adds. “(Clinicians and patients) should support each other to make informed decisions so patients feel empowered and activated.”
For clinicians, collaborating to help patients choose the best evidence-based option shouldn’t be viewed as another item on an endless to-do list but rather an essential and productive part of their roles on par with collecting patient histories, conducting exams and interpreting diagnostics.
“It can really help make a more efficient discussion and avoid multiple patients coming back over and over again,” Boeri says. “In the long run, the vision would be shared decision-making can help make things more efficient, but (making the transition) takes time.”
Clinicians must be open to reframing their role in a patient-provider partnership where the goal is understanding patient needs and preferences, providing relevant tools, and encouraging shared decision-making as part of a holistic healthcare experience.
Working in partnership with our clients, we embrace our different perspectives and strengths to deliver fresh thinking and solutions that make a difference.
Together we can unlock possibilities.
For information about OPEN Health’s services and how we could support you, please get in touch.