13 December 2017

Are you really doing shared decision-making?

Communication General Practice

Ensuring patients are actively involved in healthcare decisions requires much more than building rapport, the Australian Commission on Safety and Quality in Health Care has said.

The commission has released a two-hour online learning module, along with a series of YouTube videos, to bust myths about shared decision-making.

“A number of clinicians think they already do shared decision-making with their patients and some do this,” the commission said. “But studies tell us that what some clinicians think is shared decision-making actually isn’t.”

Shared decision-making was more than building a strong relationship with a patient, the commission said.

It involved having structured conversations covering the quantity of evidence for the risks and benefits of each health option, and an exploration about what matters to the patient.

Health decisions often had no single “best choice”, so patients often needed to make complex decisions and choose from multiple options, Dr Robert Herkes, the Commission Clinical Director, said.

“While communicating risks requires analysing and conveying complex information, few clinicians have training in how to do it effectively,” he said.

Shared decision making is not about insisting that every patient make the decision as not all patients wish to, a spokesperson told The Medical Republic. “Shared decision making is about the clinician and patient working together to determine the best course of action,” the spokesperson said.

Some clinicians assumed that shared decision-making increased the length of the consultation, but three systematic reviews disproved this, the commission said.1

Another common concern was that patients might feel abandoned during the process.

“But shared decision-making is not about leaving patients to make decisions unsupported, it’s about the clinician and patient working together to determine the best course of action for that person,” the commission said.

Shared decision-making could also reduce conflict that an uninformed patient might feel, as well as improving the accuracy of risk perception, the commission said.

Other myths were that most patients did not want to be involved in making health decisions or could not understand complex medical information.

“We know that patients want the opportunity to participate in decision-making and they want to be provided with evidence that is easy to understand and act on,” the commission said.

An Australian survey reported that over 90% of women preferred a shared role with their doctor in making decisions about screening and diagnostic tests.

Similarly, a European survey of over 8,000 people reported a high desire for shared health decision making (over 70% of the sample).3

One tool for ensuring that shared decision-making was actually occurring during a consultation was a patient-decision aid.

These aids used clear, easily understandable language to describe the benefits and risks of each option, usually with figures or graphics that made understanding the numbers easier, the commission said.

“A good place to start might be by becoming aware of which decision aids exist in your clinical area and integrate them into your clinical practice,” the commission said, directing clinicians to visit: decisionaid.ohri.ca/AZinvent.php. The learning module is available at: safetyandquality.gov.au/

References:

1 Stacey D, Légaré F, Col NF, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2014; (1): CD001431. doi: 10.1002/14651858.CD001431.pub4.

Légaré F, Ratté S, Stacey D, et al. Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database Syst Rev 2010; (5): CD006732. 27

Légaré F, Turcotte S, Stacey D, et al. Patients’ perceptions of sharing in decisions: a systematic review of interventions to enhance shared decision making in routine clinical practice. Patient 2012; 5: 1-19.

https://www.mja.com.au/journal/2014/201/1/shared-decision-making-what-do-clinicians-need-know-and-why-should-they-bother#19

Davey HM, Barratt AL, Davey E, et al. Medical tests: women’s reported and preferred decision-making roles and preferences for information on benefits, side-effects and false results. Health Expect 2002; 5: 330-340.

3 Coulter A, Jenkinson C. European patients’ views on the responsiveness of health systems and healthcare providers. Eur J Public Health 2005; 15: 355-360