The clinically excellent physician practices effective shared decision-making with patients routinely. Select recommendations outlined include using decision aids, and establishing a relationship that is egalitarian and respectful.
Shared decision-making (SDM) involves explaining treatment options, taking explicit steps to elicit patients’ values and preferences regarding treatment, and then facilitating the involvement of patients in making decisions about their own medical care. Although SDM is based on the principle of respect for patient autonomy, data repeatedly show that it is rarely achieved in practice.
Here are five recommendations to increase the use of SDM in clinical practice:
1.Guidelines that call for SDM need to be more specific.
Professional organizations that want to encourage SDM in clinical situations must clearly outline the particular risks, benefits, and consequences for patients, which would help clinicians understand its rationale. It would also be helpful to identify or create patient decision aids to help clinicians and patients work together.
2.Use decision aids.
An unstructured conversation without comprehensive written materials is not the best format to convey the complexity of information that a patient needs to participate in important decisions. Well-developed, written decision aids must be part of the solution.
3.Prioritize decisions that benefit most from SDM.
The notion that all decisions should be shared, even routine and obvious ones, is impracticable and may frustrate clinicians with limited time with each patient. For each moment spent discussing each basic decision, there is a moment not spent doing something potentially more valuable. It seems reasonable for clinicians to prioritize the use of SDM for clinical decisions that have substantial consequences for patients or that may be preference sensitive.
4.Create an interpersonal environment that facilitates engagement.
The conditions in which SDM can occur —within patient-clinician relationships that are egalitarian, respectful, and warm —are created throughout the encounter, not just at the moment of a decision. Clinicians should create environments in which patients feel in control and free to ask questions and disagree when they want to.
5.Give recommendations thoughtfully.
Strict SDM standards discourage clinicians from giving a recommendation, which may deviate from the moral intuitions of clinicians who are trying to support their patients. We suggest that clinicians may sometimes offer a recommendation that seems responsive to and consistent with that patients’ values, and especially when explaining their rationale.
SDM is a means to respect patients as individuals and to deliver care consistent with their values and preferences. These recommendations are intended as a practical starting place to provide medical care in which decision-making is more respectful and patient-centered.