Shared Decision Making

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Harnessing the power of SDM for the physician and patient

As we navigate the changes in healthcare, patients continue to embrace their role as healthcare consumers.  As consumers, patients increasingly value healthcare much like other personal services: they want to be treated as valued customers and engage in bidirectional communication regarding their treatment and wellness options with their healthcare providers; they want quality service that is personalized to meet their unique medical and personal needs; and they value healthcare providers that actively listen to and proactively engage them as partners working to achieve a shared goal of managing illness or maximizing the health.

Given the focus on outcomes, cost and satisfaction, providers are looking for effective ways to more actively engage patients. Providers are exploring multiple approaches to addressing patient needs, to actively and clearly communicate with them, while empowering them to become responsible and knowledgeable healthcare consumers.

Shared decision making (SDM) is an effective component of delivering quality care to patients while engaging them as consumers. SDM is a process of open communication aimed at transforming the relationship between physician and patient to benefit both parties. With SDM, physicians are encouraged to take the time to understand patients’ personal needs, concerns and circumstances that could affect choices of treatments, recovery and their overall health. Physicians then inform and educate patients on treatment options available to them (i.e. minimally invasive vs. open surgery), allowing them to be a part of the choice. The SDM process provides patients with the support they need to make the best individualized care decisions, while allowing physicians to feel confident in the care they prescribe. Recent studies have also shown SDM approaches can result in lower medical costs.1

Patient expectations, experience and satisfaction are already playing an important role in healthcare delivery and payment models across the spectrum of care. For example, in Medicare’s Hospital Value-Based Purchasing Program, patient satisfaction measures will comprise 20% of hospitals’ total performance scores for fiscal year 2016.2 Similarly, recent data show 84% of healthcare leaders identify patient experience as a top-three priority and 85% increased time or resources invested in patient experience in the past year.3

SDM helps patients understand their diagnoses, options and care plans, and to make the most informed and beneficial treatment decision for their specific situation. Consider, for example, a patient who seeks his or her physician’s advice on weight loss. The path that is right for the patient will depend on many different factors, including health history and status, weight loss goals, history with weight loss attempts, personal preferences and motivation, and family or social support. With SDM, a physician can help a patient explore which treatment is best for that individual based on a number of factors, including age, gender, health, degree of obesity and individual concerns and needs, for example. Together, they can have an open conversation and decide between lifestyle modifications, drug therapy and bariatric surgery.

While the benefits of SDM are clear, implementation challenges remain. Consider, for example, the following:

  1. Individual patients feel differently about how much they want to be involved in healthcare decisions, so there’s no “one size fits all” approach. Levels of patient interest and engagement vary. A survey conducted at the University of Texas MD Anderson Cancer Center found more than half (58%) of patients preferred shared roles in decision-making about their care, while 36% preferred patient-controlled decisions. Only 6% preferred physician-controlled decisions.4 To prevent illness, value their health and become engaged consumers, patients should accept personal responsibility and seek to build effective, working partnership relationships with their providers. Patients should actively, proactively and clearly communicate their health concerns to their providers, and ask questions as necessary to better understand tests, diagnoses and treatment options.
  2. Physicians don’t think they have sufficient time for patient interactions and SDM. A common misconception among physicians is SDM takes up too much time during the patient visit. However, SDM should be viewed as an efficient, worthy and active exchange between a different set of experts; physicians “give their expertise” from a medical standpoint and the patients “give their expertise” from a personal needs and lifestyle standpoint. Furthermore, SDM positions patient communication as a team effort, and encourages physicians to bring in other experts and the broader care team as a follow-up to their discussion with the patient. Overall, SDM does not take up too much time as it encourages greater interaction and collaboration with the goal of minimizing illness and maximizing patients’ health.
  3. There is a myth that patient experience and clinical outcomes are unrelated. Many physicians view patient experience initiatives as peripheral to their missions as physicians: to provide their patients the best care possible. However, excellent patient experience, including better coordination and clearer communication, drives positive clinical outcomes. Excellent physician communication and strong care team coordination are required to engage patients and improve health outcomes, both critical components of patient experience.

SDM has the potential to advance patients and physicians’ shared goal of better health outcomes and improved satisfaction. While providers should be committed to incorporating this process into their organizations, implementing SDM may be easier said than done. A suite of patient engagement resources are available, including communication guides and SDM apps.


References:

  1. Enhanced Support For Shared Decision Making Reduced Costs Of Care For Patients With Preference-Sensitive Conditions, Health Aff February 2013 vol. 32 no. 2 285-293
  2. The Total Performance Score Information. Available at: https://www.medicare.gov/hospitalcompare/data/total-performance-scores.html.
  3. Patient Experience and HCAHPS-Little Consensus on a Top Priority, Health Leaders Media, August, 2012.
  4. Kehl KL, Landrum MB, Neeraj K. Arora NK et al. (2015) Association of actual and preferred decision roles with patient-reported quality of care: shared decision making in cancer care JAMA Oncol, 1(1):-. doi:10.1001/jamaoncol.2014.112.
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About Author

Diane M. Francis, MPH

Senior director of health economics & market access at Ethicon, Inc. Ethicon has been an advocate of shared decision making since 2006 and has collaborated with national payers and providers in the development and deployment tools addressing surgical treatment options. Ms. Francis holds a bachelor's degree from Cornell University and a master's degree from Columbia University.