Not long ago, I was talking with a news reporter about an article we published on how surgical decisions are made. The paper reported that surgery patients too often were not given enough information about reasonable options. During our discussion the reporter remarked that the findings of the study were all well and good for some people, but didn’t apply to her elderly dad. Her dad would never have wanted to have information or be involved in medical decisions about his care. Instead, he would just look to his wife to tell him what to do.
We are pleased to announce the release of our newest report on shared decision making (SDM) research. For nearly a decade, the Informed Medical Decisions Foundation has funded research grants and fellowships to help broaden our knowledge of how medical decisions are made, and how to increase patient involvement in the process. “We’ve reached a juncture where we thought it was a good time to put together a document that displays some of the highlights of the research we have supported over the last few years,” says Floyd J. Fowler, Foundation senior scientific advisor. “There are things we know now that we didn’t know just a few years ago that are highlighted in this report, which we hope can help researchers and others promote shared decision making moving forward.”
This article describes the current issues surrounding informed patient decision making and how the use of SDM might improve informed decision making. The authors suggest using health information technology to bolster the use and simplify the implementation of SDM, by using it to trigger the delivery of information and collect and store information. The authors also suggest the use of additional surveys to assess patients’ knowledge and goals. The article reviews public and private developments that could facilitate the development of tools and methods to improve patient-centered care. Finally, the authors review policy options for implementation of SDM.
This article proposes that a new measure of decision quality be implemented in health care settings in order to ensure that patients receive the care they want and understand their health care decisions through measuring concordance of care given to patient preferences. The authors state that the quality of a clinical decision is the “extent to which it reflects the considered needs, values, and expressed preferences of a well-informed patient and is thus implemented.” They suggest that a valid assessment of decision quality would require: 1) decision-specific knowledge 2) values for the salient outcomes and 3) treatments chosen. The paper provides examples where similar measures have been incorporated into care processes.