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Shared Decision Making

 

Some medical decisions are fairly clear – if you break a leg, the recommended treatment is a cast, elevation, and crutches. But, many health care decisions – particularly those made in the primary care setting – fall into a gray zone because current evidence supports more than one legitimate option. Selecting a course of action for these preference sensitive conditions involves evaluating the tradeoffs among the possible outcomes of each medical choice and arriving at a decision that best suits each individual’s values and preferences. For example, some people will choose surgery for prostate cancer while others will select watchful waiting.

Too often decisions about preference sensitive conditions are heavily driven by clinician judgment without enough attention to patient preferences. However, research shows that when patients are fully informed about their options, they often choose very differently from their clinicians. Use of Shared Decision Making (SDM) and patient Decision Aids (DAs) provides clinicians with the tools to present unbiased, evidence-based information to patients to help them make a treatment decision in partnership with family, caregivers, and the health care team.

Many clinicians currently use a Shared Decision Making (SDM) approach, even if they’re not familiar with the terminology. SDM informs patients of the pros and cons associated with each medically reasonable treatment or screening option and engages the patient in making an informed, values-based choice among the alternatives. SDM is a useful approach for addressing preference sensitive conditions.

SDM is a patient-centered approach that benefits both patients and providers. Informed patients feel better about the decision process when they are able to discuss their preferences, values and concerns with their clinician. These patients are more likely to stick with the regimens the treatment requires, and they often end up rating their health better after treatment.

Clinicians report that using the SDM approach supplemented by DAs allows them to have higher level conversations. With the SDM approach, clinicians find that their patients enter the conversation with a better understanding of their options, alternatives, and possible outcomes, allowing the clinician and patient to engage in a discussion that can incorporate the patient’s values and preferences as well as the clinician’s judgment and experience.

 

Next: Decision Aids