Shared Decision Making

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By Stephen E. Perkins, MD

In health care, the concept of shared decision making is becoming more accepted, both by patients and physicians alike.

Shared decision making acknowledges that there is no single right answer for everyone and that many medical decisions involve value judgments. Medical interventions have risks and benefits that many patients may value differently.

In shared decision making, the decision process is shared between patient and provider. Shared decision making doesn’t remove the physician’s opinion from the ultimate decision; instead, it gives weight to a patient’s opinion when a legitimate choice is available.

Shared decision-making encourages physicians to include, as part of their treatment routine, consultations with patients about options and outcomes.  In this way, the patient can relay his or her opinions about the options resulting in a shared decision about treatment.

Some conditions such as chronic back pain, early-stage breast cancer, and early-stage prostate cancer are conditions that fit well into the model for shared decision making.  The doctor provides evidence-based treatment information to the patient and, in turn, receives input about goals, concerns and preferences.

When talking to your doctor about your condition and treatment choices, there are a few things to remember:

  • Don’t be afraid or too intimidated to ask questions
  • Your feelings do matter
  • Sometimes a medical decision needs to be made without knowing exactly how it will turn out.

Tips to Follow Before Talking to Your Doctor:

  • Take a list of questions to your doctor visit.
  • Bring a friend or family member to help you remember concerns or even remember your conversation later.
  • It is OK to take notes.
  • At the end of the visit, recap what you understand or even ask your doctor to summarize.

Remember, if you feel that you understand all of your options and have had an open communication with your doctor, you will leave your doctor’s office feeling better informed and more in control of your healthcare.

A good health care decision will be informed and evidence based, but it will also take into consideration the patient’s concerns and values. Both patient and provider need to weigh the pros and cons of any decision.

Advantages of Shared Decision Making

  1. Shared decision making increases patient satisfaction and may lead to better outcomes.
  2. Patients who are empowered to make decisions have more favorable health outcomes, including decreased anxiety, quicker recovery and increased compliance with treatment regimens.
  3. Greater patient involvement leads to lower demand for health care resources.

Shared decision making can be difficult because it balances two elements that can be in opposition to one another. One is the patient’s right to have input into their treatment options; the other is a physician’s responsibility to provide the best evidence-based health care.

However, when it works correctly, the treatment course will be one that reflects what is most important to well-informed patients who understand their options and the potential outcomes of treatment.

Elements of Shared Decision Making

According to the American Medical Association (AMA), there are three “core” elements of the formal shared decision-making process:

  1. Clinical information. This is a synthesis of relevant scientific evidence about the patient’s medical condition, available treatment options, potential risks, and the benefits and outcomes for each option. Ideally, the clinical information should reinforce what a patient has already learned from his or her physician.
  2. Values clarification. This is designed to help patients evaluate the more subjective elements of their medical condition and options. There are physical, emotional and social aspects of each treatment option and patients need to see how their lives might be affected by various treatments. Patient testimonials may be used or questionnaire-type tools that can help patients evaluate their choices and priorities for treatment.
  3. Guidance and communication. This is what helps patients synthesize the clinical and values information to make a decision with which they are comfortable.

Stephen E. Perkins, MD, is Vice President of Medical Affairs, for UPMC Health Plan.