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Using Shared Decision-Making to Spark Quality Patient Care

Although still not widespread, shared decision-making is on the rise due to supporting research and policy demands.

Shared decision-making is on the rise due to increasing policy demands.

Source: Thinkstock

By Sara Heath

- Shared decision-making in healthcare is an effective strategy for incorporating patient preferences into treatment plans.

Taking the time to educate patients about their conditions and treatment options, and then prompting them to contextualize that information within the backdrop of their personal preferences, ensures that patients receive quality healthcare that meets their satisfaction.

However, this practice hasn’t ubiquitously made its way into the clinician office. This is likely due to workflow barriers providers face, according to Peter Goldbach, MD, Chief Medical Officer of Health Dialog.

“Physicians work in a fairly chaotic atmosphere and are understandably very concerned about not missing anything that is important and making sure they get the information that is needed to make the correct diagnosis,” Goldbach said in a recent interview with PatientEngagementHIT.com.

Peter Goldbach says shared decision-making is lacking due to large physician workloads.
Peter Goldbach, MD, CMO Health Dialog Source: Peter Goldbach

“Sometimes what gets lost in that is the fact that the patient you’re working with may not really understand their condition,” he continued. “It’s very confusing to be a patient and it takes the provider a while to arrive at a diagnosis. But eventually providers need to share that diagnosis with the patient, let them understand it, and have a chance to let it sink in.”

READ MORE: Shared Decision-Making Reduces Cardiac Admissions from the ED

The connection between shared decision-making and patient-centered care may seem clear. After all, patients must know about and understand their conditions to take part in their own care. Even so, it’s still not a fixture in patient engagement strategies.

“It’s not really a part of our education as providers to sit down and work with patients about their lifestyle and preferences,” Goldbach explained. “We don’t usually do this in our interactions. Patients are essentially making decisions in the face of what you might call avoidable ignorance.”

In the instances where clinicians do engage their patients in shared decision-making, the outcomes are optimal, Goldbach said.

“The goal of shared decision-making is to make that dyad of patient and provider work better by bringing a better informed patient to a better informed provider,” Goldbach noted.

With the use of decision aids, an area in which Goldbach and his team at Health Dialog specialize, clinicians can educate their patients in their health, empowering patients to make informed decisions.

READ MORE: Overcoming Engagement Barriers to Shared Decision-Making

Decision aids offer an understandable, comprehensive review of the patient’s condition and treatment options, and prompts her to think about how all of this will fit into her lifestyle needs and preferences.

Ultimately, decision aids drive shared decision-making by ensuring both patients and providers bring their unique perspectives to the table to select the best possible treatment option.

“The patient is the expert on the patient, so the provider needs that information. The provider is the expert on the disease, so the patient needs that information,” Goldbach stated. “Together, they can do the best job in terms of finding an approach to a clinical problem.”

Reports about the benefits of decision aids – and shared decision-making in general – are slowly but surely sparking the growth of the technique in the healthcare industry, Goldbach said.

The insurgence of shared decision-making is stemming from a logical, scientific process, he asserted. Healthcare professionals are researching and analyzing the practice, showing its benefits. Medical practitioners then adopt shared decision-making into their workflows because they believe it will benefit their patients.

READ MORE: Patient Satisfaction and HCAHPS: What It Means for Providers

For example, an analysis by the Cochrane Group shows that shared decision-making can cut down on preference-sensitive surgeries. This reduces the risk for surgical complications and increases patient satisfaction.

Massachusetts General Hospital and Group Health Research Institute in Seattle have also both published separate studies in Health Affairs that highlight the use of decision aids in shared decision-making. Both studies resulted in an increase in shared decision-making, and in Seattle this resulted in fewer preference-sensitive surgeries.

Going forward, Goldbach thinks that mandates from government agencies will continue to drive shared decision-making. Policymakers are increasingly integrating the process into quality payment models, effectively making it a required practice for all clinicians receiving government payments.

“What I think is happening next is the government – like CMS, which years ago declared their interest in moving toward a value-based care system – have been sequentially stepping along usual processes to make shared decision-making part of the services they are probably going to require,” Goldbach explained.

For example, Washington state policymakers have developed a standard by which healthcare professionals can develop and use decision aids. The National Quality Forum (NQF) has since issued a whitepaper on developing decision aids, as well.

In December, CMS announced that through the Center for Medicare & Medicaid Innovation, it will issue grant funding for both accountable care organizations and direct-to-member programs for implementing shared decision-making.

The National Committee for Quality Assurance (NCQA) has also proposed integrating shared decision-making into the NCQA data set. The agency is currently accepting comments on the proposal.

“I think that’s going to be groundbreaking. In the past, shared decision-making was the right thing to do, but it was the un-funded right thing to do,” Goldbach said.

“Now, with this research from NQF and NCQA, it’s going to become a part of the payment scheme for value-based payment,” he continued. “I think what they’re going to end up doing is visualizing shared decision-making as a quality initiative.”

“That’s great because there are a lot of places where shared decision-making can really help people,” Goldbach pointed out. “There is the usual place where you think about someone considering a preference-sensitive surgery. But there are so many people who live with chronic disease who are struggling and not doing well.”

Shared decision-making can help chronic disease patients, Goldbach asserted. Patients who work with their providers to carve out self-management strategies are naturally more likely to adhere to those treatment plans, ultimately reducing avoidable healthcare costs.

There will also be a humanistic benefit to integrating shared decision-making into national quality improvement programs: patients will stay healthier. As Goldbach mentioned, improving patient care has always been the overarching goal for shared decision-making.

“Shared decision-making is built to enhance patient understanding about choices and helping people make informed choices,” he concluded. “Because policymakers are going to be defining shared decision-making through a quality lens, as they include it in value-based payment, they’re going to look at not only reduced medical spend, but also increased quality of care.”

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