The Importance of Shared Decision Making
Written By: Daniel Kao, AGACNP-BC
What Is Shared Decision Making?
Although many patients may not have heard the term Shared Decision Making (SDM), it is a model that has been around since 1951, and one may participate in without even knowing it. Shared Decision Making involves a conversation between healthcare providers and patients to determine goals of care, treatment options, patient preferences, values and expectations of both the provider and patient; a cornerstone of patient centered care. Surprisingly, it wasn’t until recently that doctors would consider a patient’s opinion in their treatment course. The first formal study to evaluate whether an equitable doctor-patient relationship is beneficial was in 1959. The study found that “modern” doctors who were more accepting of an active role from the patient found that they were more likely to include new innovations in therapy for their patients. “The patient should have the freedom and chance to say what he thinks about a certain therapeutic Approach.” The words shared decision making didn’t enter into the healthcare field until 1982, when a president’s commission for the study of ethical problems in medicine recommended that physicians need to involve patients into their own care2.
Barriers to Shared Decision Making
Despite how natural it may seem for a shared decision making model to exist, there are many barriers that exist where this model may not be implemented in a clinical practice. One of the more serious mindsets that exist is the myth that “not everyone wants shared decision making.” A 2018 study performed where the use of SDM was implemented in the Emergency Department (ED) found that all patients surveyed wanted at least some degree of involvement in medical decisions made3. Another systematic review which looked at 5 studies regarding the use of SDM in the ED found that patients would benefit from decision making involvement and that there is no reason not to implement SDM into clinical practice4. Another barrier that may persist is that the provider may feel like they are already engaging in SDM. A 2013 systematic review of 33 studies found that many places had very little patient involvement practices (OPTION Score 23+/- 14 On 0-100 Scale). Those that did have higher SDM efficacy implemented SDM and longer time spent with patients5. Although providers may not be actively disengaging from SDM, and in fact do participate but it may be that they do not engage patients enough.
Efficacy Of Shared Decision Making
Despite how good SDM may sound in theory is there quantitative evidence showing the advantages of SDM? A literature review of nine articles that studied the Quality of Life (QoL) in patients with low risk prostate cancer with SDM, demonstrated a positive and significant correlation between QoL and SDM7. Patients that had a good relationship with their providers felt a higher Quality of Life in various aspects such as self-efficacy, decisional control and knowledge. Another study looked at 86 studies involving over 20,000 participants to evaluate how decision aids helped patients make treatment decisions. It found that patients became more decisive, found decisions that reflected their own values, and increased their knowledge base8.
The more empowered a patient is, the more effective the shared decision making model can be. It can only help the patient when they are engaged and given the tools to learn more about their conditions and the options they have. The initial steps in helping the patient rests with the provider. As the one who has the expertise, it is up to the provider to help make the confusing medical world understandable. Although the physician may need to be more proactive in initiating SDM, there needs to be an active role by the patient to participate as well. If the patient is willing to tell the provider their wishes, the provider can help tailor medical treatment that is best for the patient. Right Device seeks to empower the patient through education;
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- Menzel H, Coleman J, Katz E. Dimensions Of Being Modern In Medical Practice. JChronic Dis 1959;9:20–40
- The President’s Commission For The Study Of Ethical Problems In Medicine And Biomedical And Behavioral Research. A Report On The Ethical And Legal Implications Of Informed Consent In The Patient-Practitioner Relationship. Washington, DC; 1982.Schoenfeld, E. M., Goff, S. L., Downs, G., Wenger, R. J., Lindenauer, P. K., & Mazor, K. M. (2018).
- A Qualitative Analysis Of Patients’ Perceptions Of Shared Decision-Making In The Emergency Department: “Let Me Know I Have A Choice”. Academic Emergency Medicine. Doi:10.1111/Acem.13416Flynn, D., Knoedler, M. A., Hess, E. P., Murad, M. H., Erwin, P. J., Montori, V. M., & Thomson, R. G. (2012).
- Engaging Patients In Health Care Decisions In The Emergency Department Through Shared Decision-Making: A Systematic Review. Academic Emergency Medicine, 19(8), 959-967. Doi:10.1111/J.1553-2712.2012.01414.XCouët, N., Desroches, S., Robitaille, H., Vaillancourt, H., Leblanc, A., Turcotte, S., . . . Légaré, F. (2013).
- Assessments Of The Extent To Which Health-Care Providers Involve Patients In Decision Making: A Systematic Review Of Studies Using The OPTION Instrument. Health Expectations, 18(4), 542-561. Doi:10.1111/Hex.12054Moumjid, N., Gafni, A., Brémond, A., & Carrère, M. (2007).
- Shared Decision Making In The Medical Encounter: Are We All Talking About The Same Thing? Medical Decision Making,27(5), 539-546. Doi:10.1177/0272989x07306779Menichetti, J., Valdagni, R., & Bellardita, L. (2018).
- Quality Of Life In Active Surveillance And The Associations With Decision-Making—A Literature Review. Translational Andrology And Urology, 7(1), 160-169. Doi:10.21037/Tau.2017.12.34
- How Do Decision Aids Affect The Understanding And Decisions Of People Facing Health Treatment Or Screening Decisions? (2017). Cochrane Clinical Answers. Doi:10.1002/Cca.1693