This is why shared decision-making is crucial for patient outcomes

Medical Economics recently spoke with Peter Goldbach, MD, chief medical officer with Health Dialog, a provider of population health management services, on the importance of shared decision-making in medical care and improving patient outcomes.

Goldbach will be among the featured speakers at a March 2018 National Quality Forum workshop on shared decision-making, sponsored by Thomas Jefferson University in Philadelphia.

Peter Goldbach, MD

ME: Let me start by asking you to define the concept of shared decision-making.

PG: Shared decision-making is a collaborative process that enables patients and providers to make healthcare decisions together that take into account the best medical information as well as a patient’s preferences. 

ME: Why is it important to healthcare and particularly to improving patient outcomes?

PG: Well, you know research has shown that patients often make decisions in the face of what some have termed to be avoidable ignorance.  For example, out of the University of Michigan some time ago there was a telephone survey called the Decisions Trial.  And it found that for eight out of 10 decisions, less than half of the respondents could answer more than one knowledge question related to the treatment that they received.

So it’s very common that patients have very incomplete information when they’re asked to make a decision.  And these kinds of medical decisions for which there are choices are very common.  There’s also research that shows that physicians often make or help make patients make decisions without having knowledge about patient preferences. So shared decision-making is there to try to help the physician/patient dyad work better.

ME: How can doctors help patients fill that knowledge gap?

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PG: Yeah, that’s a great questions and it’s not easy as you can imagine a clinical practice is a very busy place and there’s a lot of knowledge that needs to be transferred.  And so part of shared decision-making usually involves the use of an instrument called the decision aid, which is a way of helping patients get educated about using unbiased information about their medical condition, about the various evidence-based treatments that might apply to their situation and it gives them unbiased information about the expected outcomes, both positive and negative, and then also invites them to think about their lifestyle and their preferences to try to consider which treatment choices might work best for them and help them prepare to work with their physician.

ME: What is the role of family members in shared decision-making?

Next: Where can doctors go to learn more about shared decision-making?

PG: That’s a great question, and they play an important role.  A lot of times the patients like to share their decision aid information with the family member.  Often when we’re coaching patients we ask them to consider bringing a family member to the consultation as well. So having that sort of friendly third party sit in, another set of ears to listen, maybe someone to remind you about concerns that you might have to help facilitate the conversation.

ME: How can medical practices, particularly small or solo primary care practices, how can these practices incorporate shared decision-making into their treatment protocols?

PG: I think one of the first thing to know is that for many practitioners it’s not been part of their training or experience.  So it’s foreign to them.  They may think they’re doing it today but they’ve just haven’t had a chance to get educated and learn about the principles of shared decision-making.

So certainly awareness and inspiration always help and so getting to know what shared decision-making is, the expected benefits of shared decision-making for your patients in your practice is really, really useful.  And then trying to find a practical way to integrate shared decision-making is very important.

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So for many really small practices, they have the opportunity to bring aids in as sort of a library that they can make available to their patients.  And some practices, actually when patients check in, offer them a check sheet that lets the patients become aware that they have shared decision-making aids and that they can sort of check them out or have them prescribed.

ME: Where can doctors go to learn more about shared decision-making?

PG: So there’s a lot of literature on shared decision-making.  Cochran has reviewed shared decision-making three times and has a great bibliography. Looking up the National Quality Forum (NQF website) and these papers that I’m referencing, they all have great bibliographies on shared decision-making.

Health Dialog (healthdialog.com) has a lot of information on shared decision-making. We’re a population health management company and we have been doing shared decision-making now for over 20 years. So we have a lot of experience and we have published papers about health plans using shared decision-making and also our experience with provider groups.