Shared Decision Making: Why Aren’t We There Yet?

David Foster, Sr. Director, Analytics and Insight

Consumers, patients, members, employees, and families are still the greatest untapped resources in healthcare. At Healthwise, we’ve been repeating this mantra since Vern Wilson (an assistant secretary for the U.S. Department of Health, Education, and Welfare) said it back in the 1970s. It inspired our founder to start a nonprofit with a mission to help people make better health decisions. Our mission is tightly aligned with the concept of shared decision making. We feel it’s important to continue advocating for the practice of collaborative health decision making, even though scalable implementations are not at the level we expected to see by 2020.

This week, the 10th International Shared Decision Making Conference convened to discuss patient-oriented SDM research.1 At this meeting, the world’s leading SDM scholars discussed the importance of involving patients in their care. So why hasn’t the American healthcare industry incorporated this health services research into the standard of care? Part of the answer has to do with confusion around what SDM is and how it can help with the Quadruple Aim. Once we agree on a definition and a direction, we’ll be able to increasingly involve patients in their healthcare choices.

Karandeep Singh, an assistant professor of learning health sciences, internal medicine, and information at the University of Michigan in Ann Arbor, views increased patient involvement as a necessity rather than an option. “As patients increasingly exercise their autonomy in medical decision making as a result of more readily available resources, health professionals have a duty to support consumers in ways that go well beyond the bedside.”2

Shared decision making helps providers actively engage patients in their health care journeys. When care teams and individuals work together to evaluate options, everyone wins.

The shared decision making model

Shared decision making brings clinicians and patients together to make decisions about tests, treatments, procedures, and care plans. By using tools and health education designed to help weigh the pros and cons of each option, the patient can make informed choices based on their preferences and values. This patient-centered model promotes satisfaction, reduces inappropriate use, controls costs, and improves outcomes.

Shared decision making in action

Clinician buy-in is crucial for SDM to work, which means you may need to address misconceptions about the shared decision making model with your team. For instance, some clinicians worry they won’t have time for face-to-face collaboration. But shared decision making doesn’t have to be a long, in-depth meeting; rather, it unfolds over time, with the patient and provider coming together periodically to touch base and ask questions.

Decision aids allow patients to educate themselves and evaluate options on their own time and at their own pace. These aids outline the pros and cons of the choices, provide more information on each, and ask probing questions to see how the patient feels about the decision. People who use decision aids come to their next appointment better informed and ready to make a choice.3 Help your team understand that the shared decision making model actually saves time.

Research shows that a team-based approach can reduce surgical intervention by up to 20%.4 Shared decision making can also help organizations maintain HCAHPS ratings and other accreditation through higher patient satisfaction scores and increased patient education.

Shared decision making for patients

In a 2017 survey, physicians estimated that 20% of healthcare costs fail to help patients stay healthy or avoid getting worse.5 Respondents claimed that patient requests and/or patient pressure were factors in overtreatment 59% of the time. The shared decision making model minimizes this overtreatment by educating patients and helping them decide for themselves whether they should have tests, undergo surgery, take medicine, or choose treatments. Including patients in the decision-making process provides opportunities for better patient/provider relationships. In fact, people are 3 to 5 times happier with their providers when they feel included in this process.6 They’re also more likely to stick with their care plan when a decision aid is used to make decisions about a chronic condition or a procedure requiring extensive recovery.

In this age of information overload, perhaps the most valuable function of shared decision making is the ability to help patients decide whether to undergo certain testing. Just because a test exists doesn’t necessarily mean it’s warranted or helpful—and the bite-sized online articles about each often add to patient confusion. Having an informed discussion about screenings such as abdominal aortic aneurysm, the “breast cancer gene” (BRCA), colorectal cancer screening, and lung cancer can help patients decide which procedures are right for them given their unique circumstances and preferences. It’s personalized medicine not at the molecular level but at the level of values and beliefs.

While we haven’t seen large-scale implementations, let’s keep looking for small opportunities to put SDM research into practice. The good news is that when shared decision making is practiced regularly, it becomes easier for providers to spot opportunities. To get started, check out our infographic, “8 Steps to Shared Decision Making Success.”

1 https://www.fourwav.es/view/935/info/
2 https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.05404
3 https://ascopubs.org/doi/full/10.1200/CCI.17.00148
4 https://www.ncbi.nlm.nih.gov/pubmed/24470076
5 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5587107/
6 https://nam.edu/perspectives-2014-shared-decision-making-strategies-for-best-care-patient-decision-aids/