Shared Decision-Making Is More Than Just Another “Tweet” Or Buzz Word
One of the challenges we in health care face in today’s digital age is the trend to reducing complex ideas and concepts down to “sound bites.” It is often impossible to fully convey important ideas and concepts in 140 characters of less. But people try anyway … me included.
And because social media makes it so easy to share stuff online, these heretofore complex ideas and concepts quickly begin to lose their true meaning. After all, do you really read everything you “like”, “retweet” or “share” on line in great detail?
Take the concept of “shared decision-making” for example.
At face value, a “shared decision” is one made involving two or more people, e.g. the patient and physician. The term brings to mind a physician describing to a patient the pros and cons of a one or more options. A little information is shared and BAM … a shared decision is born.
So it is great pride that you “Tweet” out that 75% of your physicians say that they routinely involve their patients in shared decision making. You get even more excited when you learn that you can also brag about the fact that 100% of your patients say in your satisfaction survey that their physicians routinely involved them in important health decisions.
But if you would take the time to learn more about a subject than can be taught in a 140 character “Tweet” you would learn that shared decision-making involves a lot more than a physician talking to a patient about “pros and cons” of a particular procedure or treatment.
You would discover that there are actually evidence-based “best practices” outlining how clinicians should go about engaging patients in shared decision-making conversations. You think to yourself …oh this IS more complicated than I thought.
Take a quick look at the following “practices” adapted from the Center for Informed Decision Making and you will see what I mean.
Physicians engaging patients in “shared decision-making” should:
1) Tell patients that there are multiple options for accomplishing X … list all the options … and then invite patients to join in choosing the option that is “right” for them.
2) Describe all the
options to the patient (and family if applicable) … not just the options that the clinician prefers or assumes the patient will want.
3) Provide the patient with intelligible information on the benefits and risks of each option.
4) Help the patient evaluate the options based upon the patient’s goals and health values…not what the clinician assumes they should be.
5) Feel the patient out in terms of where they are at in terms of making a decision. Maybe they need more information or time. Maybe they want the clinician to decide … let the patient tell you what they prefer … the clinician should not project their choices on to the patient.
6) Discuss “next steps” once a decision is made.
Now be honest and ask yourself….
Do you really think that 75% of your physicians are employing best practices likes those described above when it comes to engaging their patients in shared decision making?
Similarly … do you really believe that 100% of your patients have a “clue” what shared decision-making is really all about?
Of course they don’t. But they should … and could if your organization benchmarked the shared decision-making practices that really mattered. And that’s just the point. We don’t measure and benchmark much of what really matters when it comes to the important stuff like listening to patients, empathizing with patients, exploring the patient’s health goals and perspective and so on.
Like anything worth doing … engaging patients in share decision-making the right way takes so effort and some skill. The same is true for active listening, mindfulness and being empathetic. They all take time and require skills that most physicians have long forgotten or never learned at all.
But when done right can pay off big time for physicians and patients in terms of improved outcomes, reduced costs and great patient (and physician) experiences.
Edwards, A. & Elwyn, G. (2006). Inside the black box of shared decision making: distinguishing between the process of involvement and who makes the decision. Health Expectations, 9(4), 307–20.
Fowler, F. J. Gerstein, B. S. & Barry, M. J. (2013). How patient centered are medical decisions. Results of a national survey. JAMA Internal Medicine, 173(13), 1215–21.
Informed Medical Decision Foundation Website http://www.informedmedicaldecisions.org/what-is-shared-decision-making/shared-decision-making-resources/