Shared Decision-Making

Practitioner Newsletter - Issue 3, 2011

Our health care system is constantly evolving and new treatment options introduce themselves on almost a daily basis. It becomes more difficult for practitioners to define and treat their patients with the “gold standard of care” when there are multiple options to sort through. With the current appointment time constraints and the greater variety of available options, it may be more convenient for practitioners to recommend what they consider to be the optimal treatment for their patients. These recommendations may involve past experiences, medical training and relevant professional research; however, they may not include the patient’s personal preference(s). Ultimately, the decision of what treatment is pursued needs to include the patient’s goals and needs. The practitioner-patient relationship, when both parties work together to reach a consensus for a preferred treatment, is called shared decision-making (SDM).

According to the Agency for Healthcare Research and Quality (AHRQ), a US Department of Health & Human Services agency, SDM “operates under the premise that armed with good information, consumers can and will participate in the medical decision-making process by asking informed questions and expressing personal values and opinions about their conditions and treatment options.”

The generalized (and simplistic) model of SDM involves:

Informing the patient—This is often accomplished through technology such as videos or interactive quiz templates but could be a discussion and may include introduction to evidence-based references.
Implementing the two-way interaction while respecting your patient’s values, preferences and expressed needs.
Shared deliberation—confirm a decision and timeline (if needed).

SDM has been shown to improve health outcomes as patients feel a greater responsibility for their health care. This concept can be linked back to Prochaska and DiClemente’s Stage of Change Model and the resistance that a patient may demonstrate if they are in a pre-contemplative stage which means they may be lacking knowledge on treatment options. When a pre-contemplative patient is compared to one who is in a preparation or action stage, the adherence and potential outcomes are much greater. The informed patient has a stake in the decision which then improves their willingness to adhere to the treatment course. The added control engages the patient to make educated choices about their personal health. Utilization of SDM tools help patients feel that they have a say in what happens to them instead of being told what they need to do by their practitioner.

Some critics of shared decision-making maintain that patients are not able or willing to make their own health care decision; however, there is considerable evidence that patients want more information and greater involvement in decision making in partnership with their practitioners.

The purpose of SDM is to help guide patients through available options. The true goal of SDM is for the practitioner to help the patient:

Create knowledge of the risks and seriousness of diseases or treated conditions.
Understand preventive services including risks, benefits, uncertainties and alternatives.
Weigh his/her values regarding potential benefits and harms associated with the service.
Engage in decision making to the depth with which they are comfortable.

When the goals listed above are met, an informed decision results. There have been studies to show that upon meeting the criteria mentioned above, there are several benefits. A patient who is empowered by having a say in health decisions will demonstrate:

Amplified sense of self-efficacy.
Increased sense of trust in the patient-practitioner relationship.
Improved knowledge about treatment options including risks, benefits, uncertainties and alternatives.
Improved treatment expectations for realistic outcomes.
Decreased conflict between patient and practitioner if treatment results are not optimal.
Enhanced sense of responsibility when choosing between treatment options with close tradeoffs.

There are many benefits to incorporating SDM into daily patient encounters. While it may seem to place a greater demand on times in this technology savvy society, SDM allows patients to clarify their options and provides you with the opportunity to provide access to reliable resources. As the health care world continues to evolve and grow it becomes more and more important for patients to play a larger role in what is right for their personal health care. Through SDM, practitioners have a tool that acts as a stepping stone for increasing patient responsibility.

Back to Newsletters