By Holly Hayes
An article in the New England Journal of Medicine titled, “Shared Decision Making — The Pinnacle of Patient-Centered Care” by Michael J. Barry, M.D., and Susan Edgman-Levitan, P.A. discusses the importance of the active engagement of patients and their families in health care decision-making. Healthcare is so fragmented and complex in the current environment, patients are often overwhelmed by the treatment options available. Caregivers are often not aware of their patient’s values and how those values impact the medical decisions that must be made.
When more than one viable treatment or screening option exists, clinicians can facilitate shared decision making by encouraging patients to let clinicians know what they care about and by providing decision aids that raise the patient’s awareness and understanding of treatment options and possible outcomes. Decision aids, which can be delivered online, on paper, or on video, can efficiently help patients absorb relevant clinical evidence and aid them in developing and communicating informed preferences, particularly for possible outcomes that they have not yet experienced.
Just as there are randomized trials of tests and treatments, there have been randomized trials of shared decision making supported by patient decision aids. According to the latest Cochrane review of 86 trials published through 2009, the use of patient decision aids for a range of preference-sensitive decisions led to increased knowledge, more accurate risk perceptions, a greater number of decisions consistent with patients’ values, a reduced level of internal decisional conflict for patients, and fewer patients remaining passive or undecided.5 The use of decision aids is also associated with patients’ choosing prostate-specific–antigen tests for prostate-cancer screening and major elective surgery less often, which suggests that shared decision making could be a tool to help address the problems of overdiagnosis and overtreatment.5
Through shared decision making, clinicians can help patients understand the importance of their values and preferences in making the decisions that are best for them. Experience has shown that when patients know they have options for the best treatment, screening test, or diagnostic procedure, most of them will want to participate with their clinicians in making the choice. This interest is shared by patients worldwide, as demonstrated by the recent release of the Salzburg statement endorsing shared decision making, authored by representatives from 18 countries.
In our post Patients Engage in Their Own Care More Often When Encouraged by Providers, we discuss the traditional provider/patient roles and how conflict engagement skills can be of benefit to healthcare providers in engaging patients in a shared decision model.
We welcome your thoughts on shared decision making in healthcare.
Holly Hayes is a mediator at Karl Bayer, Dispute Resolution Expert where she focuses on mediation of health care disputes. Holly holds a B.A. from Southern Methodist University and a Masters in Health Administration from Duke University. She can be reached at holly@karlbayer.com.
