Featured Shared Decision Making PublicationsView all results of this resource type.
This article describes a study that found that patients with cancer who viewed a video of various goals-of-care options, in addition to a verbal description were more likely to prefer comfort measures and avoid CPR. The study found that these patients were also more knowledgeable regarding advanced care treatment options and felt more certain about their decision compared to patients only hearing a verbal narrative. This article differs from some other studies regarding decision aids since other uses of video decision support tools have focused on helping people make treatment or screening decisions, whereas this video was used to initiate end-of-life discussions.
This is the most comprehensive review article that examines evidence of patient decision aids from numerous randomized control trials and provides a strong evidence base for the positive benefits of patient decision aids. The review finds that when patients use decision aids they: a) improve their knowledge of the options b) have more accurate expectations of possible benefits and harms c) reach choices that are more consistent with their informed values and d) participate more in decision making.
This document includes a cost analysis of implementing SDM for eleven procedures and estimates the savings to national health spending to be $3.8 billion over 5 years and $9.2 billion over ten years.
This brief provides an overview of the basic tenets of SDM, the challenges of participating in SDM from the provider and patient perspective, and opportunities to adopt SDM in health reform. It contains a helpful review of numerous policy options that could be used to encourage adoption of SDM, including incorporating SDM into meaningful use criteria for electronic health records. Though these options are not state-specific, they could be applied to state policy.
This article reviews the status of SDM implementation in the U.S., including state and federal activity, research funding and implementation in clinical practice. Also included is a helpful list of organizations that are advocating SDM use in the US, professional and accreditation organization activity in SDM, and a list of current activity in the development of patient decision aids.
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 largely theoretical article describes the balance between two medical decision making principles – beneficence and autonomy – and the growing shift towards a model of an autonomous, informed and participatory patient. The article proposes that shared decision making (SDM) strikes a balance between beneficence and autonomy and thus it should be adopted more widely. The authors review policy options for implanting SDM more widely through practice models, state policy incentives, and federal requirements. The article provides some detailed examples from health systems and states that have implemented SDM through the above models, and proposes a three-step process for implementing a nationwide practice of SDM.
This article describes a survey of 3,010 adults age 40 and older to assess the frequency of which they made decisions regarding 1) initiation of prescription medications for hypertension, hypercholesterolemia, or depression 2) screening tests for colorectal, breast, or prostate cancer and 3) surgeries for knee or hip replacement, cataracts, or lower back pain. The study found that 82.2% of participants reported making at least one medical decision in the preceding 2 years, with 83% making a decision about screening, 61% about medications and 44% about surgery. The high frequency of medical decision making lends further weight to the importance of conducting shared decision making during routine care for these and other conditions.
This article explores evidence that shared decision making can help reduce health disparities by improving patient activation and health outcomes, even for patients with lower health literacy. The authors suggest this is imperative since previous research shows that despite lower knowledge scores, patients with less education and income felt extremely well informed with respect to medication and screening decisions.
This comprehensive article examines the current status and history of informed consent requirements and argues that states should clarify their informed consent requirements to include shared decision making (SDM) as a prerequisite to a valid informed consent. The article reviews the challenges associated with modern informed consent practices and the ethical and legal foundations of informed consent. It also examines the clinical evidence for treatment patterns and patient information needs that suggest a weakness in the current legal standards. It then compares the effectiveness and implications of the three different standards of informed consent, physician-based, patient-based and shared medical decision making, and analyzes the policy implications required to implement SDM.
This article provides details of a study that found that using a decision aid in conjunction with shared decision making offered protection for physicians against a malpractice ruling in a mock trial. Focus groups representing potential jurors were presented with a case where a man was sued after being diagnosed with prostate cancer following an earlier decision not to obtain a Prostate Specific Antigen (PSA) test due to his physician’s advice. When potential jurors in focus groups were told the physician showed the patient a video decision aid for a PSA test, 94% felt the standard of care had been met and only 4% felt harm had been caused. This offered significant protection compared to only a note in the medical record, where 72% of potential jurors felt the standard of care had been met and 23% felt harm had been caused.
This brief article summarizes a systematic review of peer-reviewed literature that assesses current consumer and provider perspectives on the process. Both consumers and providers’ attitude towards SDM was more likely to be positive than negative, whereas engagement was somewhat more likely to be lower than higher. The authors conclude that actual engagement in SDM behavior is lagging behind attitudes toward the process and recommend implementation of policies that support SDM.
This article reviews a research study where patients with selected medical conditions and predicted high health care costs were given telephone-based care-management coaching to instruct them about SDM, self-care and behavioral change. This research goes beyond previous care-management studies because it included patients at risk for a preference-sensitive condition decision in the future, and the health coaching included shared decision making and access to patient decision aids. The average monthly medical and pharmacy costs per person in the enhanced-support group were 3.6% lower than those in the usual-support group, largely due to a 10.1% reduction in annual hospital admissions.
In response to the National Institute for Health and Clinical Excellence's (NICE) guidelines on patient experience quality standards, the authors aim to provide an overview of the guidance. This editorial discusses key points of the NICE guidelines, as well as the benefits of implementation and the challenges that remain.
This article discusses the use of patient decision aids in routine clinical practice for patients considering knee replacement surgery. The decision surrounding a diagnosis of knee osteoarthritis is an example of a preference-sensitive decision, meaning there is more than one viable option. Unfortunately, when patients are not fully informed, they are often unsatisfied with the outcome due to unrealistic expectations and a lack of understanding of the potential benefits and harms. The authors describe how implementation of patient decision aids, to support a shared decision making process, may address these issues and improve patient satisfaction, specifically in the context of knee replacement surgery.
The author discusses the recent focus on the need for patient engagement in health care, specifically the need for patients to play an active role in their own health care. Patients should be fully informed about their health care and work with their provider to make the decision that is right for them. The author discusses how health literacy, shared decision making and quality improvement are all related to the concept of patient engagement. The author also focuses on evidence in support of interventions designed to engage patients in their health care.
This short book outlines the importance of strong communication skills and illustrates how health care providers might using shared decision making in their consultations with patients. Inspired by Secretary of State for Health, Andrew Lansley's phrase "nothing about me, without me," the authors aim to expand on the meaning of Lansley's vision. The authors define the term "shared decision making", provide examples of skills necessary to implement this process and outline actions necessary to make this vision a reality.
What about policy regarding SDM? SDM is on the national policy agenda and has been prioritised as part of the health reform bill currently going through the Houses of Parliament. The NHS Constitution emphasises patients' right to be involved in decisions and this is reinforced in standards set by professional regulators. What about tools - Decision support for patients? The UK governments have invested in patient information and a few decision aids are freely available on public websites.
This comprehensive report builds upon the National Academy for State Health Policy's analysis of state health improvement initiatives and discusses the process and potential of shared decision making in state legislation. The authors examine the legislative and regulatory approaches in Maine, Minnesota, Oregon, Vermont and Washington. The report provides examples of implementation challenges and strategies, as well as lessons learned from the experience.
The author discusses the concept of preference-sensitive decisions, that is, decisions where multiple reasonable options exist, and how a shared decision making process is critical to addressing this specific area of medical decisions. The article also looks at patient decision aids and how these educational tools can complement shared decision making by making the practice of high-quality medical care both more effective and more efficient. Lastly, the author discusses the role of shared decision making in state and federal policy and how this legislation can assist in making shared decision making a routine practice in medical care.
Nothing about me without me was the guiding principle adopted by 64 participants from 29 countries at a 1998 Salzburg Global Seminar convened to develop ideas for improving the quality of health care by involving patients. The catchphrase has now resurfaced in the coalition governments new plan for the NHS in England, which sees patient choice and shared decision making as key mechanisms to create a patient centred and quality focused NHS.
Policies to promote shared decision making are becoming prominent in the United States, Canada, and United Kingdom. This is partly because of a recognition of the ethical imperative to properly involve patients in decisions about their care and partly because of the acrruing evidence that the approach has benefits. Shared decision making is an approach where clinicians and patients make decisions together using the best available evidence.
Posted in Health Care Policy, Patient Involvement, SDM Implementation
Tagged Angela Coulter, decision-making, evidence-based medicine, Glyn Elwyn, NHS, patient autonomy, patient engagement, patients, shared decision making
There has been increasing interest in the use of "decision aids", defined as adjuncts to the discussions clinicians have with patients during deliberations about decisions: these aids provide information about options and help clarify personal values. These adjuncts range from leaflets through face to face methods such as coaching or counselling to interactive multimedia websites. To describe this generic family of clinician-patient interventions we will use the term decision support technologies (DSTs), corresponding with the internationally recognised need to assess the impact of "health technologies."
Shared decision making (SDM) is a process in which patients are encouraged to participate in selecting appropriate treatments or management options. Not being properly told about their illness and the options for treatment is the most common cause of patient dissatisfaction. Most patients nowadays want more information and a greater say in decisions about how they will be treated. In SDM, patients are involved as active partners with the clinician in clarifying acceptable medical options and choosing a preferred course of clinical care.
Occasionally, all citizens have to make important health decisions that affect health outcomes. Strategies to support patient education and engagement should therefore be a fundamental plank of health policy. Also, patients can play an important role in understanding the causes of illness, protecting their health and taking appropriate action, choosing appropriate treatments for acute episodes of ill health, and managing chronic illness. These roles must be recognized and supported.
Policymakers increasingly believe that encouraging patients to play a more active role in their health care could improve quality, efficiency, and health outcomes. But critics have dismissed talk about patient engagement and patient centred care as political correctness -- a misplaced concern with the "touchy feely" aspects of health care, with no scientific basis and little relevance to the quest for excellence in clinical care. Who is right? To what extent is the planned shift towards greater patient engagement supported by robust research evidence?
Good quality health information is essential for greater patient involvement in healthcare. Patients and the public require information that is timely, relevant, reliable and easy to understand. This is an essential component of any strategy to promote health literacy, self-care, choice- shared decision-making, medication adherence and self-management of chronic disease. Patients have many decisions to make about their healthcare and, like all decision-makers, they require information to inform their choices. Reliable information is also essential to help patients understand their health problems and how to deal with them.
Patient-focused interventions are those that recognise the role of patients as active participants in the process of securing appropriate, effective, safe and responsive healthcare. There is a growing belief among policy-makers that patients/citizens can contribute to quality improvement at both an individual and a collective level.
Health systems throughout the world are searching for ways of making their services more responsive to patients and the public. The WHO has been encouraging this by including indicators of responsiveness in its World Health Reports. Many European governments have recognized that the future of socialized health care services depends on their ability to keep abreast of changing needs and respond to these in an appropriate way in order to sustain public confidence. Regular surveys of the views and experiences of patients and the public are beginning to be seen as an indispensable addition to the panoply of performance indicators used for monitoring the effectiveness of health policy. We report here a survey of random population samples in eight European countries focusing on public views of the quality of doctor-patient communications and opportunities for involvement in choice of providers and treatments.
Posted in Health Care Policy, Patient Involvement, SDM Implementation
Tagged Angela Coulter, choice of provider, decision-making, doctor-patient communication, health care, health care systems, patients, primary care, shared decision making, treatment decisions, World Health Organization
There is considerable debate about when, in which circumstances, and to what extent, patients should be encouraged to participate in decisions about their care. This issue of "Health Expectations" includes some important contributions to the debate. Many advocates of shared decision-making suggest it should be restricted to preference-sensitive decisions, i.e. those where the patient's values out to guide the choice. Informed consent, on the other hand, is perceived to be appropriate, and indeed necessary, for all decisions of significant risk even if there is only one treatment possibility.
This report addresses a deceptively simple question: How can the productivity of American health care be substantially improved? Productivity, in lay terms, is the ratio of output to inputs. A more colloquial rendition of the question might be: how can we get a lot more bang for our heath care buck?
Posted in Cost, Health Care Policy, Patient Involvement, SDM Implementation
Tagged cost-effective medical care, Dartmouth Atlas, empowering patients, EMR, health care, health care innovation, informed consent, Kauffman Foundation, patients, shared decision making
Patient involvement is being encouraged by the government and by others as a way of improving the quality of the service provided in general practice. Patients can be involved in their own individual care; for example, in treatment decision making and in disease management; or collectively, by providing feedback on aspects of practice organisation and quality.
Improving responsiveness to patients has been a goal of health policy in the United Kingdom for several decades. Until now, most initiatives in this area have failed to change noticeably the everyday experience of most patients in the NHS. The harsh realities of budgetary pressures, staff shortages, and other managerial imperatives tend to displace good intentions about informing and involving patients, responding quickly and effectively to patients' needs and wishes, and ensuring that patients are treated in a dignified and supportive manner. This is the essence of patient centred care, and most health professionals strive to achieve it.
Shared decision making, in which patients and health professionals join in both the process of decision making and ownership of the decision made, is attracting considerable interest as a means by which patients' preferences can be incorporated into clinical decisions. When there are several treatment options which may have different effects on the patient's quality of life, there is a strong case for offering patients choice. Their active involvement in decision making may increase the effectiveness of the treatment.
Posted in Decision Aid Components, Patient Decision Aids, Patient Involvement, Patient Preferences
Tagged Angela Coulter, BMJ, decision aids, decision-making, patient-centered care, preference-sensitive care, shared decision making, treatment decisions
The traditional style of medical decision-making in which doctors take sole responsibility for treatment decisions is being challenged. Attempts are being made to promote shared decision-making in which patients are given the opportunity to express their values and preferences and to participate in decisions about their care. Critics of shared decision-making argue that most patients do not want to participate in decisions; that revealing the uncertainties inherent in medical care could be harmful; that it is not feasible to provide information about the potential risks and benefits of all treatment options; and that increasing patient involvement in decision-making will lead to greater demand for unnecessary, costly or harmful procedures which could undermine the equitable allocation of health care resources.
Posted in Patient Decision Aids, Patient Involvement, Patient Preferences
Tagged Angela Coulter, decision support, decision-making, health care, informed decisions, patient engagement, patient participation, patients, shared decision making, treatment decisions
With any surgery, consent must be obtained from each patient, and valid consent is based on knowledge of the options, the risks and benefits of each option, and the likelihood that these will occur for the individual patients. The legal doctrine and requirements of informed consent are well known. In theory, informed consent is a process, not a moment in time. In reality, it has occurred when a clinician requests a signature from a patient to authorize that a specific treatment or procedure take place, and the patient signs. In current practice, there is no requirement that shared decision-making occur before the signing of the consent form.
Posted in Patient Decision Aids, Patient Involvement, Patient Preferences, SDM Implementation
Tagged consent form, Dartmouth-Hitchcock Medical Center, decision aids, decision-making, informed consent, informed decisions, informed patient choice, Medicare, patient-centered care, patients, shared decision making, surgery
Support for a model of shared medical decision making, where women and their care providers discuss risks and benefits of their different options, reveal their preferences, and jointly make a decision, is a growing expectation in obstetric care. The objective of this study was to conduct a systematic review and meta-analysis of randomized controlled trials evaluating the efficacy of different decision aid tools compared to regular care for women facing several option in the specific field of obstetric care. We included published studies about interventions designed to aid mothers' decision making and provide information about obstetrical treatment or screening options.
Posted in Patient Decision Aids, Patient Involvement, Patient Preferences, SDM in Maternity Care, Special Populations
Tagged childbirth, decision aids, decision support, decision-making, doctor-patient communication, health education, informed consent, obstetrics, patient-centered care, pregnant women, shared decision making, women
The Informed Medical Decisions Foundation commissioned Lake Research Partners (LRP) to conduct research with primary care physicians about SDM and patient decision aids. These are the results: Increasingly, patients are faced with medical decisions that have many options, uncertain outcomes, and benefits and harms that are valued differently by each individual. Shared decision making (SDM) recognizes the importance of having patients and providers work together to select tests and treatments. Patients and providers bring different expertise to the decision. Providers are mainly responsible for assimilating and appropriately applying evidence-based information and patients are responsible for sharing their preferences. Using SDM, well informed patients and providers can determine which choice matches what is most important to patients -- delivering high quality care that is both evidence-based and patient-centered.
Posted in Cost, Patient Decision Aids, SDM Implementation
Tagged decision aids, decision support, health care, informed decisions, informed patients, patients, primary care providers, providers, shared decision making
Many doctors aspire to excellence in diagnosing disease. Far fewer, unfortunately, aspire to the same standards of excellence in diagnosing what patients want. In fact, we will present an accumulation of evidence which shows that preference misdiagnoses are commonplace. In part, this is because doctors are rarely made aware that they have made a preference misdiagnosis. It is the silent misdiagnosis.
A sleeper provision of the Affordable Care Act (ACA) encourages greater use of shared decision making in health care. For many health situations in which there's not one clearly superior course of treatment, shared decision making can ensure that medical care better aligns with patients' preferences and values. One way to implement this approach is by using patient decision aids -- written materials, videos, or interactive electronic presentations designed to inform patients and their families about care options; each option's outcomes, including benefits and possible side effects; the health care team's skills; and costs. Shared decision making has the potential to provide numerous benefits for patients, clinicians, and the health care system, including increased patient knowledge, less anxiety over the care process, improved health outcomes, reductions in unwarranted variation in care and costs, and great alignment of care with patients' values.
Posted in Cost, Decision Aid Effectiveness, Health Care Policy, Patient Decision Aids, Patient Preferences, SDM Implementation
Tagged ACA, CMS, Cochrane Collaborative, decision aids, Group Health, health care costs, HHS, IOM, IPDAS, Medicare, NEJM, PCORI, practice variation, shared decision making
This short article outlines the history of patient-centered care, the importance of involving patients in decisions where there is more than one reasonable option and the practice of shared decision making, and argues for their increased use.
This discussion paper argues for the increased use of shared decision making practices, citing that patients want to be involved in evidence and decisions, that there is a gap between this and what patients get, and that patient satisfaction is linked to shared decision making. These conclusions were reached through research in three stages: environmental scan, qualitative interviews and focus groups, and quantitative survey.