Why Shared Decision Making Leads to Better Outcomes


The concept of shared decision making has been around for more than a decade, but in the last several years, the push to make patients active and informed partners in their health care has really allowed it to gain traction.

This is especially true in areas of health care where patients have more than one reasonable treatment option. For instance, in the case of a heart attack there is one best treatment, but in other areas, such as macular degeneration, there are multiple reasonable treatment options. And when faced with a complex and potentially life-changing medical decision, patients are no longer willing to hand over the reins to their doctor — nor should they.

Patients and doctors have different, but equally important, expertise they bring to the table. While doctors are educated about diseases, tests, and treatments, patients know information about their bodies, their circumstances, and their health care goals. The best outcomes will be achieved when doctors and patients collaborate on making important clinical decisions together. Here’s how patient education and decision-making aids can help.

Shared decision-making programs on the rise

Formal shared decision-making programs are on the rise, and the concept is written into the Affordable Care Act as an objective of good health care. These programs feature patient-education tools such as online surveys, apps, and videos, and are designed to meet specific goals: to help people thoroughly understand their choices and help them make informed decisions, and also to curb health care costs by sometimes steering people away from expensive treatments that are not likely to result in better health or improved patient satisfaction.

A national study on shared decision making is underway: the High Value Healthcare Collaborative (HVHC), funded by the national Centers for Medicare and Medicaid Services (CMS). Study participants watch a video that depicts actual patients who discuss their condition and how they arrived at their various choices. The video describes treatment options and the pros and cons of each. After watching the video, patients participate in a phone or in-person discussion with a health professional.

“Shared decision making doesn’t replace the doctor-patient relationship. But in an era when doctors are, in fact, substantially more stretched for time, it is good to have tools to help them leverage their time with patients,” said Dr. Tom Rosenthal, chief medical officer for UCLA hospitals, one of the 20 health care delivery systems involved in HVHC.

How the right decision-making aids can help

It’s not necessary to adopt a formal shared decision-making program to reap the benefits in your practice. Any physician can embrace the philosophy of shared decision making, which is really just a matter of approaching patient interactions as collaborative instead of one-way directives from the doctor.

Decision-making aids that can foster this approach include group educational classes, pamphlets, and videos created specifically for the purpose of educating patients. These tools also help patients clarify their treatment goals, values, and objectives. Everything from the patient’s age, financial resources, cultural and religious beliefs, and family support can factor into the decision-making process. For this reason, tools that can easily be shared with family and caregivers after the patient appointment—like videos on your practice’s web site or patient portal — are especially advantageous. This way nothing is “lost in translation,” and patients can access the information on their own time whenever they want.

There is a push for CMS to begin certifying and implementing patient decision-making aids — randomized trials consistently demonstrate their effectiveness. A 2011 review of 86 studies showed that, “compared with patients who received usual care, those who used decision aids had increased knowledge, more accurate risk perceptions, reduced internal conflict about decisions, and a greater likelihood of receiving care aligned with their values,” according to a recent article in the New England Journal of Medicine.

As computers and health information technology become an increasingly important part of patient visits, doctors are relying on technology to assist with informed medical decision making.  Studies on computerized decision aids have shown them to be as effective as their non-computerized counterparts—and in fact could be more efficient to use at the point of care while also meeting meaningful use criteria. Of course, doctors must be mindful of the fact that some patients can perceive computers in the exam room as barriers to communication with their doctors.

When used correctly, patient education tools — especially high-quality visual materials—can be effective aids in the shared decision-making process.

To find out more, or for a demo of Rendia, our internet-based patient education software, get in touch today.

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