- Interventions targeting patient and provider behaviors are notably effective in improving provider communication and shared decision-making, says a recent study published in Health Affairs.
The study, conducted by a research team led by Ming Tai-Seale, PhD, MPH, investigated different intervention types and how they affected patient engagement and satisfaction levels. As the healthcare industry continues to value patient engagement in care, shared decision-making becomes a high priority for healthcare professionals.
“Shared decision making is not only conducive to reducing information asymmetry but also is ethically the right thing to do,” the research team explained. “Systematic reviews of the preconditions for improving health care delivery have emphasized the importance of shared decision making as a mediator and moderator of health care quality.”
To better understand approaches to improving shared decision-making, the team investigated two different interventions – Ask Share Know (ASK) and Open Communication (OpenComm) – by applying them individually and in tandem at three different clinics. The research team also tested a control clinic in which no intervention method was tested.
After implementing the interventions at four clinics, Tai-Seale and her team measured patient perceptions of care using three different tools. First, the team immediately issued a questionnaire, CollaboRATE, which measured patient experiences through questions about providers’ efforts to engage the patient.
Next, the team used the Perceived Involvement in Care scale to measure how well the providers facilitated shared decision making. Patients rated their physicians on a 0-9 scale on factors including whether the physician took their opinions into consideration and if the physician provided a full summary of medical symptoms and treatment.
Lastly, the team issued the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, generally measuring how well the provider respected the patient and her preferences and needs.
Overall, patients at all facilities felt respected by their providers regardless of the shared decision-making intervention at play. However, the CollaboRATE and facilitation scores showed differences in patient experiences at the four tested clinics.
When examining the CollaboRATE scores, the researchers found that patients at the OpenComm clinic were 1.5 times more likely to give their providers the highest scores possible than those at the non-intervention clinic. The differences in provider scores at the ASK clinic and the OpenComm ASK combination clinic were not significant in comparison with the non-intervention clinic.
With regards to facilitation of shared-decision making, patients at the OpenComm clinic were 1.5 times more likely to give their providers the highest score than those at the non-intervention clinic, while patients at the ASK clinic were 1.6 times more likely to give their providers the highest score.
In a qualitative analysis of OpenComm and ASK, the researchers found that patients and providers alike responded well. Patients reported increased motivation to better prepare for future doctor’s appointments. Providers said the interventions introduced several useful approaches to improve shared decision-making, but that training in the programs should be streamlined to become less burdensome and time-consuming.
Overall, the researchers concluded that targeted approaches to influencing patient and provider behavior improved levels of shared decision-making.
Although providers reported that following these interventions was difficult work, the researchers conjectured that the changing landscape and providers’ tendencies to do right by their patients will motivate them to adopt sometimes difficult patient engagement strategies.
“While behavior change takes effort, many providers might be motivated to change how they engage with patients because it is not only important to patients, but it is also the ethical thing to do,” the research team stated.
Likewise, patient satisfaction has become an increasingly important topic as several healthcare organizations adopt value-based models. By facilitating shared decision-making practices, providers can achieve better outcomes through more satisfied and better engaged patients.
“As the nation transitions physician payment incentive from rewarding volume to rewarding value, accountability should be anchored on patient-centered care, delivered through patient-centered communication,” the research team concluded.
“It is incumbent upon healthcare systems to empower and enable patients to inform their primary care providers about the issues that matter most to them, to truly understand their options, and to share in decision making to the extent that they prefer.”