The Affordable Care Act (ACA) identifies patient engagement as an integral part of quality in accountable care organizations. In fact, a separate section (3506) of the ACA calls for new Shared Decision-Making Resource Centers to help integrate the approach into clinical practice.
Shared decision making means that patients and their healthcare providers make healthcare decisions together in a way that takes into account the patient’s values and preferences. By incorporating the provider’s expert knowledge and the patient’s right to be informed of the potential benefits and side effects of all care options, patients receive the support they need to make informed healthcare decisions.
Studies have reported improvement in satisfaction, treatment adherence, and quality of life when healthcare providers involve their patients in making key decisions about treatment choices.
To fully engage patients in shared decision making, it may be a good idea for healthcare providers to recommend that a caregiver or friend or family member take part in discussions. They may be more inclined to ask questions and can take notes that may help the patient consider treatment options after they leave the doctor’s office.
The top four steps that healthcare providers should take to engage patients in shared decision making are:
1. Dedicate adequate time to helping patients make these decisions. Numerous studies have pointed out that the number one barrier to implementing shared decision making is time constraints. Recognize that helping a patient make an important healthcare decision will take some time and try to factor it into your schedule.
2. Make sure patients know the options that are available. Describe treatment options, explain how they differ from one another, and justify these options. Ask the patient what they’ve heard about these options. If a patient says, “Just tell me what to do,” a good response may be, “I’d be happy to share my views, but first, let me describe the options in detail.”
3. Provide more detailed information about treatment options. Describe treatment options in detail and discuss their potential risks and benefits. Use decision aids, which are tools designed to help patients choose between different treatment options. These include leaflets, books, websites, videos, and interactive media that help patients make treatment decisions by highlighting the risks and benefits of different treatment options.
4. Provide decision support to the patient. Summarize treatment options and ask the patient what matters to them most. Ask if they are ready to make a decision. If they are not, ask what information would help them decide.
In general, shared decision making has the greatest impact in patients with chronic illnesses such as diabetes or heart disease, who see their physicians multiple times and need to make long-term decisions, versus patients who have only a single visit.
Shared decision making has benefits from both an outcomes and a cost perspective. In a large, randomized study, one group of patients was given decision-making support by trained health coaches via phone, mail, and the Internet. The other group received a usual level of support from these coaches. In both cases patients received information about treatment options, were given support to help them identify their preferences, and were encouraged to discuss their preferences with their doctors.
By the study’s end, patients who received enhanced decision-making support had overall medical costs that were 5.3% lower than the usual support group, 12.5% fewer hospital admissions, and 20.9% fewer heart surgeries.
As educators, we need to help healthcare providers understand that healthcare decisions should be influenced by exploring and respecting “what matters most” to each individual patient, and that patients can only develop an informed preference if they have the information and support to base it on.