The Importance of Shared Decision-Making in Healthcare

Whether you are dealing with a new medical condition, or one that is progressing, it is important to take the lead role in your medical team. Historically, a doctor would tell you your diagnosis and course of treatment, and you would do your best to follow the doctor’s orders. Fortunately, times have changed, and most doctors now work with the patient to make treatment decisions together, called “shared decision-making”.

What exactly is shared decision-making in healthcare?

According to the Informed Medical Decisions Foundation, shared decision-making is a “collaborative process that allows patients and their providers to make healthcare decisions together. It considers the best clinical evidence available, as well as the patient’s values and preferences.”

Certainly, this model makes sense – the doctor is an expert in clinical experience, but the patient is the expert of their own wants, needs, concerns, and lifestyle.

What are the benefits of shared decision-making in healthcare?

Shared decision-making leads to better outcomes and lower costs. For instance, researchers found that patients who actively engage with their providers in decision-making are better informed and understand their health care options better.

Furthermore, these patients tend to make better decisions about their own care, choosing options they are more likely to adhere to. This combination of informed choices along with increased treatment compliance improves quality of care and lowers costs.

Additionally, researchers found that among patients complaining of chest pain, shared decision-making “increased patient knowledge about their risk, increased engagement, and safely decreased the rate of admission to an observation unit for cardiac testing“.

And another study suggested that shared decision-making can decrease patient anxiety about healthcare costs because it helps patients choose the treatment that best fits their personal budgets and their healthcare priorities.

How can doctors engage patients in shared decision-making?

The beginning of any conversation on treatments must start with a clear description of the patient’s medical condition, including the impact on daily life and long-term outcomes.

After the patient and family understand the condition, the doctor should explain the pros and cons of each treatment option, including possible side effects, expected recovery time, the impact on the quality of life, and the long-term prognosis.

Importantly, doctors should make sure patients understand their options, by using plain language and visual aids. Doctors should have patients and families summarize the information to make sure all is correctly understood. Certainly, language interpreters should assist as needed.

Although many doctor appointments are time-limited, involving the patient and family in the decision-making process is time well spent!

Research shows some patients feel conflicted about their treatment decisions.

When patients do not fully understand the pros and cons of each available option, they can feel conflicted about the decisions they make.

Research conducted in 2020, during the COVID-19 pandemic, evaluated how patients felt about their decisions to have surgery. Prior to their surgeries, the patients answered these yes/no questions:

• Do you feel sure about the best choice for you?
• Do you know the benefits and risks of each option?
• Are you clear about which benefits and risks matter most to you?
• Do you have enough support and advice to make a choice?

The results found:

• Almost 20% of the patients were conflicted about their decision, answering “yes” to only 0-2 questions.
• 17% did not know the benefits and risk of each of their options.
• 6% were unclear about which benefits and risks mattered the most to them.
• 3.3% reported they did not feel their surgery was the best choice for them.

Unsurprisingly, 44% of the patients who had surgery during the COVID-19 stay-at-home period felt uncertain about their surgery. And almost 20% of these concerns were directly related to COVID-19 concerns. In contrast, only 17% of those who had surgery after the stay-at-home period felt uncertain about their decision to have surgery.

In addition to worries about COVID-19, many patients expressed concerns about the outcome, recovery, and wound healing.

Interestingly, non-white patients without a college education had the highest rates of decisional conflict. The researchers surmised there may be inadequate shared decision-making for this population due to a lack of doctors who are ethnically, culturally, and physically similar to them.

The results of this study indicate the need for better shared decision-making before surgery, to help patients understand their risks and benefits of their options.

Who can benefit from shared decision-making?

Everyone benefits. As stated on the Informed Medical Decisions Foundation: “Shared decision-making is appropriate for any health decision where there is more than one medically reasonable option. And evidence shows that shared decision-making benefits all patients, regardless of age or education.”

When doctors provide information about the risks and benefits of all treatment options, patients and families can make informed decisions. Clearly, shared decision-making in an office environment can be relatively easy since doctors generally know their patients and have time to discuss options.

However, what about shared decision-making in a hectic emergency room? Interestingly, a study in an emergency department found that although ERs are often chaotic and medical staff are frequently interrupted, shared decision-making in the ER can reduce unnecessary hospital admissions, something we could all benefit from.

Don’t let your discomfort stand in your way of shared decision-making.

Unfortunately, not all patients want to participate in shared decision-making. One study found that 25% of patients prefer a passive role in the process.

Why don’t more patients participate in decision-making? Researchers conducted focus-group sessions to learn how people feel about participating in decision-making and if they follow their desires to participate. The study found that people had a “strong desire” to participate in decision-making, yet many obstacles prevent most patients from doing so.

What are the barriers to participation?

The study concluded there are a few reasons people are afraid to speak up during a doctor’s visit:

• People, even those who are well-educated and relatively affluent, feel they must defer to their doctors during clinical appointments and conversations.
• Doctors can be authoritarian – which can be intimidating.
• Patients fear that doctors will label them as “difficult”.

Does your doctor include you in the decision-making process?

Certainly, doctors can, and should, foster shared decision-making. Doctors should be aware that they may intimidate their patients and should make every effort to put their patients at ease.

Additionally, doctors should actively engage all patients, even those who show reluctance, to participate in shared decision-making.

Hopefully, you have a doctor who discusses treatment options with you, allowing you to work together to create a plan. However, if you find your doctor isn’t listening to your concerns or opinions, it’s probably time for a new doctor. Look for a doctor who will respect your input and work with you collaboratively.

For tips on how to find a new doctor, read my blog post: How Do You Find a New Doctor You Can Trust?

How can you participate in shared decision making?

Since understanding all treatment options is critical to making a good decision, make sure you understand each option, including what is involved, the likelihood of success, and the potential side effects. Therefore, I recommend the following questions:

1. What are all the available options? What are the advantages and disadvantages of each option?
2. Are there any clinical trials available?
3. Do other doctors or hospitals offer different options?
4. How long is the course of treatment?
5. What are the expected results?
6. What are the possible short-term and long-term side effects?
7. How will we know if the treatment is working?
8. What if we do nothing and take a “wait and see” approach?

Once you’ve discussed your options with your doctor, consider these factors when making a decision:

1. Expected outcome
2. Type and length of treatment
3. Success of treatment in similar patients
4. Possible side effects
5. How likely you will comply with treatment requirements
6. Location of treatment
7. Insurance coverage, or expected cost, for proposed treatment

A few more thoughts.

Never feel afraid to get a second opinion – you will not be insulting your doctor! For more information, read my blog post: Why are Second Opinions Important?

And, throughout any medical journey, if something doesn’t seem right, speak up!

Learn more…

Since it’s important to fully engage in your care, read these blogs for more tips:

• Why Take Detailed Notes at Doctor Appointments?
• 10 Tips to Communicate Better with Doctors.
• How Can You Get the Best Healthcare? Actively Participate!
• Can you Trust Medical Information Online?
• Can You Trust Advice from Other Patients?
• Understanding Medical Information Is Harder Than Most Realize.
• The Dangers of Too Many Tests and Treatments for Patients.

NOTE: I updated this post on 9-21-21.