- Shared decision-making has emerged as a key patient engagement strategy for healthcare professionals working to integrate their patients into the overall care team. The practice, which elicits patient preferences for key treatments for certain ailments, requires patients and providers work together to choose the right remedy.
The process is seemingly simple: providers diagnose an issue, educate patients about treatment options and pros and cons of each, and patients and providers decide which treatment fits best into patients’ lifestyles.
Shared decision-making has the power to improve patient outcomes, reduce preventable hospital readmission rates, improve patient satisfaction, and increase patient engagement with care and recovery, the National Quality Forum’s Kim Ibarra and Wendy Prins told PatientEngagementHIT.com in an interview.
“Studies over the last several decades show how shared decision-making, and in particular use of high quality decision aids – which are tools to support shared decision-making and identifying risks, benefits, and patient values – can lead to improved patient outcomes in terms of helping patients better understand the information related to their condition,” said Ibarra, who is NQF’s senior director of quality innovation.
“Shared decision-making helps patients feel more confident about the decisions that they’re making, feel more satisfied or have better experiences with their care providers and the healthcare system,” she added.
The only problem, the pair suggested, is that not too many healthcare professionals are using shared decision-making.
There are a number of issues that have kept shared decision-making flying under the radar, Prins, who is NQF’s senior advisor for quality innovation, said. Full schedules and other time constraints often keep providers from building the meaningful relationships that fuel shared decision-making, Prins noted.
Defining shared decision-making has also presented its own set of problems.
“There's a lack of clarity around what shared decision-making really is,” Prins pointed out. “It is not just listening to a patient's chief complaint and then helping them decide what care is best for them.”
Instead, shared decision-making requires bidirectional communication between patient and provider. As the medical experts, clinicians need to fully educate patients not only about their diagnosed conditions and the potential treatments, but also about the pros and cons of each treatment.
Patients, as the experts on their own lifestyles and preferences, need to share that information with providers.
Too often, providers harbor misconceptions about when they should employ shared decision-making, Prins added.
“A lot of the work around shared decision-making has occurred in thinking about what people refer to as preference sensitive conditions,” Prins stated.
Preference-sensitive conditions are those where there are multiple treatment options that are dependent upon patient’s individual preferences. For example, knee pain can be treated through surgery or rest and physical therapy. Most providers know how to discuss those options with patients to yield optimal results.
“But, it's really much broader than that,” Prins contended. “Shared decision-making can apply to every type of clinical encounter and many are just very complex. There's a lot to unpack in the patient-clinician relationship that may not get the attention it needs.”
That’s where NQF has stepped in. Earlier this year, the organization published its Shared Decision-Making playbook to help educate providers on how to employ shared decision-making as a patient engagement strategy.
The playbook came as a part of NQF’s broader work on patient-centered care and patient and family engagement, Prins and Ibarra said. The organization has paid careful attention to shared decision-making because many of its member stakeholders have identified the practice as critical for value-based care and patient-centricity.
The playbook touches on various shared decision-making techniques and why it is an important standard of care.
Most successful shared decision-making efforts employ the use of decision aids, which help with patient education. According to Ibarra, providers must use these aids judiciously. Providers must also strategically push patient education.
“Having tools and resources that are written or produced in such a way that patients can understand them is really important,” Prins said. “Using the right language with patients is really important as well. Providers must avoid technical terms and speak the way average, everyday people would speak.”
Ibarra agreed, stating that it’s important providers foster an open environment for patients. Patients often face mental barriers when it comes to engaging with their own care. They may perceive themselves as in a less powerful position than their providers, and therefore may think they need to yield to their providers’ opinions.
It is up to individual clinicians to shift that power paradigm by building stronger patient-provider relationships, Ibarra noted.
“Shared decision-making is really about helping to build relationships and that therapeutic alliance between providers and patients,” she said. “Communication in that relationship is critical to overcoming some of these challenges and helping patients feel like they are equal partners in care.”
Going forward, NQF will continue to advocate for shared decision-making as a key standard of care, Ibarra said. All healthcare professionals should be using this strategy on their paths toward more patient-centered care.
“We'd love for every healthcare organization and all healthcare stakeholders to get a copy of the NQP playbook to see what they could implement, how they could implement it, and start doing shared decision-making consistently,” Ibarra said. “As a next step, we may collect lessons learned on how clinicians have been using the NQP playbook, what they've been learning in practice, and how others can benefit from their best practices. We’re looking at the ways that organizations either succeeded or maybe haven't succeeded so that we can really accelerate the way that shared decision-making is happening across the country.”
This work is essential because shared decision-making can help fuel so many other healthcare industry goals, Prins said. For example, reconciling prescription medication use and patient engagement presents a major hurdle in healthcare. But using shared decision-making can help reduce that burden, Prins noted.
“What really strikes me is how central shared decision-making really is,” Prins explained. “Think about issues with antibiotic stewardship, for example. Shared decision-making has a role there once you provide evidence on why you, for whatever condition the patient comes in for, why providers actually don't need antibiotics and instead should suggest home remedies, whatever they may be.”
“Many of the issues that we have in healthcare in terms of overuse of certain services could really be mitigated by more thoughtful conversations between patients and their family members and their healthcare providers,” Prins concluded.