8/29/2019
Jake Blanchard, Solutions Consultant Practice Lead
I speak with clinicians nearly every day about shared decision making (SDM). When we talk about their SDM goals, it’s clear that the pain point isn’t a reluctance to give the patient options. The real difficulties are figuring out the timing and delivery of content, knowing when to schedule appointments, establishing communication between primary care and specialty clinicians, and tracking the long-term impacts of a decision.
Or to put that in simpler terms: SDM is easier said than done.
The good news is that Healthwise works on these problems all the time and is always exploring ways to eliminate these roadblocks. Decision aids exist for most preference-sensitive situations, such as cancer screening, the best ways to manage diabetes, and whether to have knee surgery.
I see two common missteps when working with organizations that haven't been hitting their SDM objectives:
Fortunately, both hurdles can be overcome with education, cooperation, and a little visionary thinking.
Once you decide which populations or patients to target, you can choose the best way to distribute decision aids based on how those patients make their way through the healthcare maze. Different populations will take different paths. For instance, recommending cancer screening to a patient based on their age won't be the same process as an episodic decision-making event like whether to have a mastectomy.
When you educate your clinicians on SDM in a way that supports candid and meaningful options throughout the patient's care journey, you give your team the tools to reach patients the way each person wants—and needs—to be reached.
Communication between teams is one of the largest areas of improvement here. It can be difficult to implement SDM programs when only one office or department is invested. This is especially true for chronic conditions and surgeries, where multiple clinicians and nonclinical staff members need to be involved. If a primary care clinician orders a decision aid and refers the patient to a specialist without telling the other office that the patient has the decision aid, the information falls by the wayside. When this happens, either the patient misses out on valuable material that would have helped them make an informed decision, or the specialist must explain the options all over again and start from scratch.
To keep these patients from falling through the cracks, an SDM solution needs to span multiple organizations and departments. This means ensuring that the results of the decision aid live somewhere that every office can access.
What if, before the patient’s appointment with the specialist, that office gets an electronic update, letting them know that the patient has received a decision aid but has not completed it? Now someone from the specialist’s office can call the patient and remind them to read the decision aid so they can come to their appointment prepared. The results can help staff make choices before the patient arrives, such as whether to send educational material, enroll them in a program, or extend the length of their appointment.
Feeling overwhelmed? You're not alone! Successful shared decision making involves a lot of moving pieces, and the fact that those pieces span multiple departments and organizations sure doesn't make it any easier. Our "8 Steps to Shared Decision Making" infographic can help you get started.