Shared Decision Making – 30 Years On, What’s Changed? What’s Next?

Shared Decision Making has three main objectives :
patients who are, to the extent they desire,

1. well-informed about options relevant to the decision they are making,
2. helped in clarifying what matters most to them about the decision, and
3. involved in the process of decision making.

The Evidence Communication Innovation Collaborative (ECIC)’ of the Institute of Medicine has published a paper that explores ways to improve the communication and understanding of evidence important to decision-making in health care.

It has been more than 30 years since the President’s Commission urged the adoption of shared decision making (SDM) as a means to reform physician-patient communication and to improve the day-to-day implementation of meaningful informed consent to medical treatments.

When it comes to health care, patients’ preferences and values are routinely left out of important discussions between provider and patients about treatment choices. Many patients’ interactions with clinicians remain unchanged from their parents’ generation, and clinicians too often still emerge from health care training oriented to a paternal model for patient-physician communication.

The aim of this paper is ‘to suggest a set of concrete actions that could help break the logjam and facilitate implementation of patient decision aids as a routine part of clinical practice.’

The key suggestions are:

1. Certify decision aids.
The information provided to patients facing health decisions should be objectively evaluated to ensure that it:

• Meets a high standard for medical accuracy and completeness; 23
• Effectively communicates key messages to a range of patients and meets standards for patient (and clinician) usability and acceptability;
• Presents up-to-date information about the relevant pros and cons of all reasonable options;
• Presents these options in a fair and balanced way, free of influence from special interests; and
• Contains other features of decision support that evidence shows can provide significant assistance to patients facing decisions and their clinicians.

2. Set quality standards for shared decision making.
SDM measures should have the following properties:

• Include measures of how informed patients are about their options, what matters most to patients, and the extent to which patients are involved in the decision-making process.
• Measures of knowledge have to be specific to the particular decision.
• Because of the wide variation in the types of and approaches to medical decisions, any measurement aimed at comparing provider quality ought to target similar clinicaldecisions among similar patient groups.

3. Use health IT to support SDM.

• Identifying decision windows;
• Offering patients opportunities to request and receive information at the time and in
  the format they desire;

• Ensuring that information provided to patients is of high quality;
• Giving patients convenient and reliable ways of exploring and communicating their
  goals, concerns, and preferences relevant to the problems and conditions they face; 24

• Providing an easy and reliable way for patients to let their providers know about their goals, concerns, and preferences;
• Providing appropriate support materials tailored to clinicians; and
• In the future, informing patients about the extent of a provider’s use of SDM.

4. Expand the role of employers/payers in promoting SDM.

The paper and references are available here