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. You might have participated in it 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 innovations in therapy for their patients! [2].
Barriers For Patients In Shared Decision Making
Despite how natural it may seem for a shared decision-making model to exist, many barriers in clinical practice prevent this from being implemented.
Myth #1: Not everyone wants to be a part of the decision process
One of the mindsets that exist is the myth that "not everyone wants shared decision making." Some healthcare providers may assume wrongly that a patient does not want to be involved and begins to make decisions without speaking with a patient first. But that could not be further from the truth.
A 2018 study performed in the Emergency Department (ED) that implemented SDM found that all patients surveyed wanted at least some degree of involvement in medical decisions made [3]. Another study, which looked at 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 practice [4].
Including the patient in their care conversations can only have positive impacts. It also has been shown to have positive outcomes for patients after surgery! [7]
Myth #2: Healthcare providers may think they are already utilizing SDM
A third 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 minimal patient involvement practices even though they felt like they did [5]. Healthcare providers must do their best to include their patients in the conversation and play a role in helping them make decisions that affect their wellbeing.
One 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 values, and increased their knowledge base after being empowered with the knowledge they lacked [8].
Tips To Joining The Conversation
The more empowered you are, the more influential the shared decision-making model can be. You or your support circle are engaged and given the tools to learn more about their conditions and the options they have.
Here are some tips to start empowering you or your loved ones to be a part of the Shared Decision Making Model
Tip #1: It's Ok To Ask Questions!
It may often be intimidating to ask your doctor or nurse what may be happening or to clarify a new diagnosis. The first step is understanding that your healthcare provider is there for you!
It will not be the first time that your healthcare provider has heard that question and should shed some light on what is happening. They may also provide some additional reading material for further education. If you need them to explain one more time, don't hesitate to ask!
Tip #2: Do Your Research
When you hear that you may need surgery or have been diagnosed with a new medical condition, it is easy to become overwhelmed. It's ok, it's natural! After taking time to digest the latest information, start doing your research to help better understand what the outlook is and what is happening.
Websites such as WebMD or Healthline can be a start to learning more about what your new diagnosis or surgery may entail. Remember, your medical team will know you best, so their plan may vary slightly from what you may read.
The more you know, the more productive a discussion you can have with your healthcare team for the following appointments.
But be careful of misleading products or websites!
Tip #3: Know Your Medications
If you are already on medications, you already know how easy it is to lose track of when to take which medication or what the medicine is for!
Start a written or typed document keeping track of your medications and their schedule. This practice will help you and your healthcare provider know what medications you need and will. It can also help prevent dangerous drug mishaps if everyone is on the same page.
Tip #4: Speak With A PatientPartner™
Sometimes it's hard even to know where to start or what questions to ask! And many times, your medical team will help you through the medical part of your surgery, but who will guide you through the feelings and anxieties of being a patient?
That's where a PatientPartner™ comes in. A PatientPartner™ is someone who has had a joint replacement or bariatric surgery. They've been through it all and know what to expect as a patient, and have learned tips and tricks to make things easier. You can speak with one for free to know the complete patient experience before undergoing surgery!
Speaking with a PatientPartner™ has been shown to decrease anxiety before surgery and demonstrate better outcomes after surgery because you already know what to expect!
Ready to take control of your own health? Be a part of your health conversation today and connect with a PatientPartner™ for free!
References
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
