SHARED DECISION-MAKING

PATIENT AND PHYSICIAN PERSPECTIVES ON SHARED DECISION-MAKING

Shared decision-making is a concept and an action. Shared decisionmaking occurs when the health care professional and patient work to develop a treatment plan that is best for the patient. The best decision takes into account evidencebased information about the various treatment options, the physician’s knowledge and experience, and the patient’s preferences, values, and other life factors they may consider important. It is the epitome of patient centered care and requires competences from both the patient and the healthcare professional.

BENEFITS OF SHARED DECISION-MAKING FOR THE PHYSICIAN

Without appropriate expectations, patients are much more likely to be unhappy with the results of their treatment or procedure and may suffer decisional regret. Shared decisionmaking prevents this cycle by placing the patient’s preferences and values at the center of the decision-making process. Multiple studies throughout various medical fields have shown shared decision-making improves patient outcomes and satisfaction.

Shared decision-making can also be quite rewarding for the physician - not only is it an effective and ethical way to interact with patients, it creates the opportunity to deliver more patientcentered care. While some treatment options or procedures may have proven advantages in certain clinical situations, there is often no universal ‘best’ choice and as doctors, we must acknowledge that patient needs and wants can vary tremendously. Physicians must be willing to acknowledge and consider patients’ personal values and preferences while assessing and discussing what is medically appropriate and reasonable. In doing so, shared decision-making not only improves patient satisfaction and outcomes but is also an effective and extremely ethical approach in ensuring patient goals are met whenever possible.

While shared decision-making is standard of care, unfortunately it is not standard practice. An important factor here is time; many patients feel they don’t have enough time to process all the information and can feel they are being rushed into making a decision. In addition, some physicians, through no fault of their own, simply do not have adequate time to allow for a shared decision-making conversation with every patient. This is where patient-centered decision aids are invaluable, providing patients the opportunity to access and review the information they need at their own pace.

THE SHARED DECISIONMAKING TOOLBOX FOR THE PATIENT

Patients require a varying degree of autonomy in a shared decision-making consultation. It can be influenced by the resources available, the patient’s culture and experiential background, and the degree to which the patient wants to be involved in the decision-making process.

Health literacy also plays a crucial role in the level of patient interaction during shared decision-making. Some patients already have a broad understanding of what their diagnosis is before their initial consultation based on their own research. These patients are often better served by focusing on specifics of care rather than generalities. Many will rely heavily on the healthcare professional to drive the discussion. Both are considered shared decision-making as the patient is deciding the level of autonomy they feel they need.

In each scenario, there is vocabulary patients can use and skills they can practice during a consultation.

Some skills to use:

• Listening skills are paramount to a successful shared decision-making conversation. Remember, listening is a two-way street.

• Time: Knowing how much time you will have for a consult can streamline your approach and questions to ask. Not all physicians have the same time available through no fault of their own.

Some questions to consider asking:

• What are all my options?

• Can you tell me your level of experience, and success with the options, with each of the options you have presented to me?

• What are the risks and benefits of each option?

• How will this affect my current lifestyle during my recovery?

• How much support will I need at home for this treatment or surgery?

BENEFITS OF SHARED DECISION-MAKING

Patients who feel fully informed and involved in their treatment decision-making are happier, more compliant, and have better outcomes. In addition, well-informed preference-based patient decisions may lead to safer, more cost-effective healthcare, which in turn might result in reduced healthcare utilization rates.

Terri Coutee and Dr Minas Chrysopoulo