Commentary

Shared Decision-making: It Takes Two

According to the Agency for Healthcare Research and Quality, “Shared decision making is a model of patient-centered care that enables and encourages people to play a role in the management of their own health. It operates under the premise that, armed with good information, consumers can and will participate in the medical decision-making process by asking informed questions and expressing personal values and opinions about their conditions and treatment options.”

That sounds great, but what does shared decision making look like in the real world?

The Institute of Medicine’s Evidence Communication Innovation Collaborative conducted a survey of 1,068 adults, asking them about participation in shared decision making. Below are some of the findings:

  • 90% agreed that when facing a healthcare decision, they want to know all of the options, not just the physician’s recommendation. 
  • Almost 50% wanted to discuss the option of doing nothing.
  • About 60% expressed interest in learning the risks of each option, including how tests or treatments could affect their quality of life.

The statistics above show that patients are interested in discussing healthcare decisions with their doctors. However, as the survey results also showed:

  • Only 36% said that their provider clearly explains the latest medical evidence
  • 47% said that their provider takes into account their goals and concerns
  • 37% said that their provider explains the option of not pursuing a test or treatment

Why this disparity? A recent article in the British Medical Journal discussed currently available decision making tools. The authors argued that medical decisions are not always clear cut—both clinicians and patients need to rely on the best evidence and take into account patients’ values and preferences.

Unfortunately, most decision aids are designed for patients to use independently at home and are not conducive to a collaborative discussion in the doctor’s office. Additionally, they are often not based on the latest evidence and can rapidly become outdated.

The SHARE IT (SHARing Evidence to Inform Treatment decisions) project was formed to address the need for high quality and up-to-date decision tools. 

The project has three objectives:

  • To develop a platform for translating GRADE (a method of standardizing and grading medical evidence) summaries into decision aids 
  • To design a set of interactive formats for use during an office visit
  • To test the automated production of these decision aids from electronically published evidence summaries

The electronic decision aid prototype developed as part of this project uses information and evidence summaries in formats that can be accessed with a computer or on a tablet during an office visit. By using the decision aid together, patients and doctors can focus on what the patient wants to discuss first, and move on from there. 

Unlike traditional decision making tools, the ones designed by the SHARE IT project are not instructive in nature, but instead rely on the interchange between doctor and patient, who sit together and review the data.

After using the tool, one physician found that a single change—letting the patient choose what to talk about first—affected her own strategy for communicating with patients. Both sides ended up learning and engaging positively in a new way.

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