Advancing Shared Decision Making
For over two decades, the Informed Medical Decisions Foundation has been working to advance shared decision making through research, policy, clinical models and patient decision aids. We believe that the only way to ensure high quality medical decisions are being made is for a fully informed patient to participate in a shared decision making process with their health care provider.
Each “Voices” blog segment will feature a person we believe has a unique and valuable perspective on shared decision making.
Today’s guest is Maureen Corry, executive director of Childbirth Connection.
In your own words, what is shared decision making and how does it improve the quality of health care?
Shared decision making is a collaborative process that enables people to make the health care decisions that are right for them, in the context of their own lives. It draws on the expertise and knowledge of both the patient and provider. The care provider shares her medical expertise and provides evidence-based information about care options, and the patient shares her values, preferences, and concerns. Together they make a decision and carry it out The best health care decisions are made when patients and providers work together.
What do you think are the misconceptions of shared decision making?
I think patients and health care provider have different misconceptions.
In maternity care, we’ve heard some concerns from women that shared decision making means giving up some control of decision making to the care provider – essentially a move away from informed consent and refusal. Because of the history of childbirth in the United States, and many troubling practices that still happen today, childbearing women are justified in being concerned about their rights. It is critical that we help women understand that shared decision making is all about enhancing the decision making process allowing women the opportunity to voice their own values and preferences and exercise their rights of informed consent or refusal with full information.
Providers may think that shared decision making is too time consuming and may not have the skills they need to engage patients in the process. However, decision aids like those being developed by the Foundation and Childbirth Connection, have been shown to reduce the amount of time clinicians need to spend with patients explaining best evidence on care options, freeing up time for them to discuss the patient’s values and preferences and reach a decision together.
What has to happen for shared decision making to be part of standard practice? Who do you think should lead this change? (ex., patient, provider roles)
Transforming care so that shared decision making is standard practice must be a multi-stakeholder effort, with women, clinicians, hospital administrators, payers and policy makers doing their part. Childbearing women and their advocates have a critical role in demanding this kind of care. Women can “vote with their feet” by choosing providers who engage them in shared decision making and honor their right to informed choice. But they can also advocate for system changes so that shared decision making becomes the standard.
We know there are pockets in the United States where shared decision making is happening, and we can see growing interest from all stakeholder groups. However, to truly make shared decision making the standard we need changes that only policy makers and payers can implement. Payment for maternity care still rewards procedure-intensive care rather than high-quality care. Emerging reimbursement models will help align payment with quality. This highlights the need for more quality measures that evaluate shared decision making processes and outcomes. As part of our maternity care shared decision making initiative, we are developing decision quality measures to help fill those measure gaps and ensure that our decision support tools are effective.
Do you have a personal story about you (or someone you know) who has or could have benefited from shared decision making?
At Childbirth Connection, we tend to hear more about women who could have benefited from share decision making, rather than from those who actually have. We know from our national Listening to Mothers surveys of women’s childbearing experiences that informed consent processes in maternity care are grossly inadequate. For example, in our last survey just 18% of women having episiotomy reported that they had given consent for this overused invasive procedure, while 25% of women with a cesarean felt pressure from a health professional to have one. We are working to ensure shared decision making is the norm rather than the exception.
If you could change one thing about maternal health care what would it be?
If I could change one thing, it would be to put women and families at the center of our maternity care system – to engage them as full partners in their care, coordinate services around their individual needs and preferences, and hold as our highest value their health and wellbeing. This is a major part of the multi-stakeholder consensus 2020 Vision for a High-Quality, High-Value Maternity Care System, which we released in 2010. Achieving a system that is truly woman- and family-centered is a tall order that will involve reforming everything from how we measure performance and pay for care to how we manage liability concerns. We also will need to retrain the maternity care workforce and, of course, work to educate and empower women to participate actively in their care. Childbirth Connection’s Transforming Maternity Care Partnership is working to foster these and other changes, using as our map the steps and recommendations in our Blueprint for Action.
Maureen Corry, MPH Maureen has served as executive director of Childbirth Connection since 1995, positioning the organization as a powerful and effective advocate for evidence-based maternity care and maternity care quality improvement. She has 30 years experience as a researcher, educator, and policy analyst on maternal and newborn health issues. Maureen is co-leading the multi-year maternity initiative in collaboration with the Informed Medical Decisions Foundation. She is currently a member of the board of directors of the National Quality Forum (NQF) and the AMA/Physicians Consortium for Performance Improvement Maternity Workgroup. She also serves as co-chair of the 2012 National Priorities Partnership/Partnership for Patients Maternity Care Action Team, which is working to catalyze action to improve maternity care for mothers and babies. Maureen holds an MPH in health administration from Yale School of Public Health.
Shared decision making to inform and involve patients in their health care decisions is gaining great momentum as a strategy to improve the quality and value of health care. However, making patient participation in decisions the rule, and not the exception, is challenging. Now is the time to convene patient advocates, providers, health care systems, policy makers and insurers to engage in a critical discussion about how to address this challenge and make it easier to do the right thing by informing and involving patients when it matters most — when a decision is looming. Continue reading
Upcoming Stakeholder Meeting Aims to Raise Awareness of Misaligned Incentives in Health Care Reimbursement
In recent years, efforts to implement shared decision making (SDM) in routine clinical practice have advanced; however, implementation has proved challenging and numerous reports have identified misaligned incentives in health care reimbursement as a root cause. On May 23 and 24, leading researchers, providers, policy makers and payers focused on facilitating widespread implementation of shared decision making will convene in Washington, D.C. to participate in a critical discussion about how to better align incentives to foster this spread. Continue reading
As part of the first-ever Shared Decision Making Month this past March, the Informed Medical Decisions Foundation interviewed Dr. Ishani Ganguli, a second-year resident at Massachusetts General Hospital’s own primary care innovation, the Ambulatory Practice of the Future (APF) and Short White Coat blogger. The APF focuses on empowering patients to be more engaged and involved in their health care by placing the patient at the very center of the care team. Ishani was drawn to APFs model of innovation and desire to understand the whole patient over a period of time. During our conversation with Ishani, we will hear how the APF is changing the future of primary care through technology, space and processes, and how shared decision making plays a role at the practice. Continue reading
American College of Physicians Endorses Shared Decision Making Approach for Prostate Cancer Screening
In a guidance statement published Tuesday in the Annals of Internal Medicine, the American College of Physicians (ACP) joined the heated discussion on PSA testing by endorsing a shared decision making approach for prostate cancer screening. The ACP Clinical Guidelines Committee developed this guidance statement after reviewing current guidelines on prostate cancer screening in the U.S.
To this end, a shared decision making approach is appropriate for decisions about prostate cancer screening due to the preference-sensitive nature of the decision. We believe it is imperative that patient preferences be incorporated in the decision-making process and applaud the ACP for supporting a shared decision making approach for decisions about prostate cancer screening. By having an informed conversation about a diagnostic tool and disease that is often poorly understood, men can feel confident that they’ve made the decision that’s right for them. Continue reading