Sharing the decision making in health care
How to be a co-pilot with your doctor
Health care experts are rediscovering an old-fashioned concept that may help lower health care costs and improve the quality of health care: shared decision making. What is shared decision making? It is when you and your doctor work together as co-pilots as you travel through the health care system. And you have the right to ask your doctor to use shared decision making whenever you need to decide among several treatment options.
What does shared decision making mean?
Shared decision making can mean different things depending on the situation. But one of its central ideas is that we need to get patients (and, when appropriate, families) and caregivers more involved in health care decisions. The main goal of shared decision making is to give patients the knowledge and skills they need to take an active role in their health care.
Using shared decision making is especially important when a patient has a medical condition that has more than one medically sound treatment option. In these cases, there is no single, correct medical solution—the best solution depends on the patient’s personal preferences and values.
What are the elements of a shared decision making program?
All shared decision-making programs should contain four fundamental elements:
Information. Patients should receive clear and unbiased information that describes their condition, that addresses the pros and cons of different treatment options, and that helps them envision how their life might change based on their decision.
Support. Patients should be well-supported during the decision-making process. They should get help understanding the information given to them and should feel free to discuss their values and preferences with their provider.
Discussion. Patients and providers should share information and make a decision together that is based on the best medical evidence and tailored to the specific needs and circumstances of the patient.
Follow-Through. Care should be delivered in the agreed upon manner and in a way that respects patients’ preferences and values. Patients should stay in contact with their providers and continue to receive support for other health care decisions.
What are “patient decision aids”?
Patient decision aids are written, video, or web-based tools that are designed to help patients do the following:
1. Become more knowledgeable about their health condition and treatment options
2. Decide which risks and benefits are most important to them
3. Envision how the different options would affect their daily lives
When designed well, these decision aids can help patients make choices that reflect their preferences and values.
Although shared decision making programs do not necessarily need patient decision aids to be effective, it is essential that patients be well-informed and feel empowered to participate in the decision-making process.
Screening for prostate cancer: An illustration of shared decision making
About 17 out of every 100 men in the United States will be diagnosed with prostate cancer in their lifetime. However, fewer than three of every 100 men will die from prostate cancer.
The decision to test for localized prostate cancer in men older than 70 is not clear-cut, and one medically sound option is to not screen at all. Men in this age group also have time to think about their options, since prostate cancer often progresses slowly.
The decision by older men to be screened for prostate cancer is a good example of an area where a patient decision aid can be helpful. Two good decision aids are the brochure and video developed by Health Crossroads. See them at http://tinyurl.com/ydxu3we.
Where can I learn more about shared decision making?
Families USA has written an overview of shared decision making, Shared Decision Making: Engaging Patients to Improve Care, (http://familiesusa2.org/assets/pdfs/health-system-reform/Shared-Decision-Making.pdf) which answers key questions about how shared decision making works, how it can improve patient care, how it fits into a more patient-centered health system, how to design a good shared decision making program, and a list of links to other resources.
Ron Pollack is the executive director of Families USA, a national organization advocating for health care consumers.