Since 1982 when the President’s Commission first recognized shared decision making (SDM) as a concept, it’s had a healthy evolution—from the creation of the first United States (US) center for SDM at Dartmouth-Hitchcock Medical Center and the first Cochrane Review of Decision Aids in the 1990s to the development of the Mayo Clinic’s National Resource Center and inclusion of SDM in the Affordable Care Act in 2010.
Today, the number of decision aids has grown from a handful to hundreds, and the volume continues to increase as newer technologies create greater feasibility for implementing them within medical practice models of care, large and small. That said, we’re nowhere near achieving a broad, all-encompassing adoption of SDM in health care.
“In part, this is about time—creating the right system and understanding its benefits, both for your patients and for a health care environment that is moving toward value-based rather than volume-based outcomes,” says Peter D. Goldbach, MD, CMO of healthdialog, a Boston-based company that offers SDM tools and other patient engagement programs.
At its core, SDM is the concept of clinicians and patients working together to make decisions about testing, treatments and care plans based on clinical evidence that balances risks and outcomes with patient preferences and values.
That’s important, says Goldbach, because clinicians aren’t always tapped into patient preferences, and patients aren’t always well informed about their choices. Decision aids that include written materials, online modules and videos, for example, arm patients with information about their condition and treatment options, improving their ability to work with their doctors to manage their health.
“It helps doctors and patients agree on a health care plan,” says Goldbach. “And when patients are participating in these decisions and understand what they need to do, they’re more likely to follow through.”
To help practices begin thinking about or designing an SDM process, the Informed Medical Decisions Foundation (IMDF), a nonprofit organization to improve health care decision making, offers the following tips:
- Invite participation—Inviting patients to participate lets them know that their goals and concerns are a key part of the decision-making process.
- Present options—Patients must understand what is available to them.
- Provide information on risks and benefits—Share balanced information based on the best-available scientific evidence; check back with patients to be sure they understand.
- Help patients evaluate options based on their goals and concerns—To understand patient preferences, ask what is important and what may cause anxiety and worry.
- Facilitate deliberation and decision making—Let patients know they have time to think things over; ask what else they need to know or do before they are comfortable making a decision.
- Help patients follow through—Be clear about the next steps with your patients; verify that they understand, and discuss any possible challenges that might prevent them from moving forward with a decision.
“What SDM ultimately offers is a process to activate and empower patients,” says Goldbach. “It’s a more elegant form of practice conversation.”
Amy Maciejowski is a Program Manager for State Affairs at NCQA. She supports NCQA’s work with state legislators and regulators. Amy holds a master’s degree in Political Communications from American University.