Mastering Shared Decision Making: The When, Why, and How

Medical | Glyn Elwyn & Marie-Anne Durand| February 20, 2018

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Shared decision making is an approach where healthcare professionals and patients make decisions together using the best available evidence about the likely benefits and harms of each option, and where patients are supported to arrive at informed preferences.

The concept of shared decision making is well documented. Research has suggested that shared decision making can improve care, increase patient satisfaction and decrease costs. Patients who actively participate in decisions about their healthcare are better aligned with the issues that matter most to them and that fit into their personal situations. Costs of health care can be reduced when patients choose less risky operations, or use their medication more effectively. Initial research suggests benefits related to reduced professional stress and burnout levels. There may also be added benefits for low-literacy populations.

The medical community, in large part, believes in the power of partnering with patients to make decisions based on patient preferences. But data shows that shared decision making does not always occur. One study found that clinicians reported actively engaging in shared decision making, but when researchers examined recordings of conversations between clinicians and patients, there was little evidence to support the claim.

Part of the reason for the lack of shared decision making can be attributed to the culture of healthcare. Clinicians are taught to diagnose, make clear authoritative recommendations, and explain those recommendations to patients. It is typically faster to suggest one way of doing things, and it takes less effort to explain a recommendation, rather than undertake a process of comparing multiple options. A good example of this mindset is how the medical community develops and uses clinical practice guidelines. Clinical practice guidelines make recommendations, (literally best practice statements), and clinicians are strongly encouraged to follow these recommendations. Rarely do clinical practice guidelines make it clear that there are a range of reasonable alternatives available to patients.

Research has suggested that shared decision making can improve care, increase patient satisfaction and decrease costs.

A shared decision-making model was developed in 2012 in an effort to educate clinicians about how to implement shared decision making. It’s called the three-talk model, and it’s based on a theoretical approach that describes collaborative deliberation. The three-talk model includes three components.

  • “Team talk” involves reassuring patients that although there are decisions to be made, they will have support as they learn about, compare and consider alternatives.
  • “Option talk” is where information about the various options are provided to patients. Giving the right amount of information is key. Too much, and patients will be overwhelmed. Too little, and it is impossible to compare the harms and benefits of options.
  • “Decision talk” aligns the goals of care with the patient's informed preferences.

Keep reading to learn what shared decision making is, what it isn’t, and how clinicians can craft the conversation and put shared decision making into action.

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Glyn Elwyn & Marie-Anne Durand
Glyn Elwyn, MD, MSc, FRCGP, PhD & Marie-Anne Durand, BSc, MSc, MPhil, PhD, CPsychol

Glyn Elwyn, MD, MSc, FRCGP, PhD Professor, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, USA Glyn Elwyn is a physician-researcher, Professor and Senior Scientist at The Dartmouth Center for Health Care Delivery Science and The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, USA

Marie-Anne Durand, BSc, MSc, MPhil, PhD, CPsychol Assistant Professor, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, USA Marie-Anne Durand is a Health Psychologist with a Doctoral Degree in Medicine and a longstanding interest in evidence-based public health and applied health services research.

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