There is little question that shared decision making (SDM) benefits patients and providers alike. According to the Society of Decision Professionals, the group that hosts the annual Shared Decision Making Summit, shared decision making is built on three pillars:
Patients. In the SDM model, patients are vital partners in their own healthcare decisions.
Providers. Moving toward SDM means “shifting the mindset” of providers so they are open to considering a patient’s values and preferences, including cultural, religious, or otherwise, when making treatment decisions.
Data. SDM relies on both patients and providers having access to the right education and data at the right times along the care continuum so patients are fully empowered.
When these elements come together, patients are empowered to take an active role in designing their own treatment and management plans, and patient comprehension and engagement increase, positively effecting everything from a patient’s perception of care to the actual outcomes and cost of treatment. In fact, studies even suggest that patients who are empowered with good information often choose more conservative (and therefore less costly) treatment options.
Despite these well-documented benefits, there remain significant obstacles to the rapid and widespread implementation of SDM. These range from the perception that many patients don’t want to be involved in their care (“Doctor knows best”) to questions about clinical work flow, patient comprehension of evidence-based medical information, cultural differences between providers and patients, institutional resistance from providers, and the inescapable time pressure that characterizes so many provider / patient interactions in today’s healthcare system.
So how can we do a better job of implementing shared decision making? Britain might have some answers. Almost a decade ago, the National Health System commissioned a long-term study called MAGIC (Making Good Decisions in Collaboration) that designed, tested, and identified the best ways to implement shared decision making into the National Health System. With results coming out, here are some of the things researchers learned:
Training that emphasizes the difference between shared decision making and the traditional clinical workflow is necessary. Many providers assume, “I already work to educate my patients,” when shared decision making represents more of a cultural shift than an intellectual one.
Patient education materials are crucial. This includes material like risk grids and treatment option sheets that can help quickly communicate options to patients, so they can make more informed decisions. When used at the point of care, these tools helped stimulate patient questions and a more robust decision-making process.
Patient activation efforts can make a big difference. Although there is a perception that many patients don’t want to be involved in decisions, researchers found a more complex picture. In reality, many patients felt overwhelmed and underqualified to speak up, or they felt like they would be annoying their providers. Patient activation campaigns that focus on comprehension, asking questions, explaining what shared decision making is, and respecting the patient’s wishes were shown to increase the number of patients actively making decisions.
Shared decision making begins at the top. On an individual level, providers are often very pressed for time and dealing with multiple pressures, both institutional and financial, that can actually de-incentivize shared decision making. Support from leadership is essential to making it work.
Stacey D, Bennett C, Barry M, Col N, Eden K, Holmes-Rovner, M Llewellyn-Thomas, H Lyddiatt A, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews. 2011.
Joseph-Williams N, Lloyd A, Edwards A, Stobbart L, Tomson D, Macphail S, Dodd C, Brain K, Elwyn G, Thomson R. Implementing shared decision making in the NHS: lessons from the MAGIC programme. BMJ. 2017 Apr 18;357:j1744.