The Importance of Shared Decision Making

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?

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.

The importance of shared decision making.

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.

Which patients 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.”

Shared decision making has been taking place in doctors’ offices, where patients and doctors have a chance to work together over time. However, a recent study in an emergency department found that although EDs are often chaotic and medical staff are frequently interrupted, shared decision making in the ED can reduce unnecessary hospital admissions. Certainly, most patients want to avoid hospitalizations. And less hospitalizations saves money.

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

Why are people reluctant to participate?

The study concluded that 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?

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. Ask the following questions:

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

Because there are many factors to weigh then making a decision, consider the following:

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.