What Is Shared Decision-Making in Healthcare
Two of my favorite sessions at this year’s annual meeting for the Alliance for Continuing Education in the Health Professions focused on shared decision-making (SDM) in healthcare. SDM is becoming a bit of a buzzword in the CME/CE field and is increasingly recognized as part of value-based care and reimbursement, though it has been proposed as an ideal model of treatment since at least 1997.
What Is Shared Decision-Making (SDM)?
The concept carries myriad meanings. However, at its core, SDM is a two-way communication process that involves clinicians and patients working together to make decisions and achieve a common aim. SDM should include at least two participants (provider and patient) making decisions together.
Each party should share information, try to reach a consensus about treatment and work to agree on the treatment plan together. Recent scholarship emphasizes that effective shared decision making in oncology can improve outcomes and treatment adherence, reduce care variations, and enhance satisfaction.
As Regina Sih-Meynier, Group Management, Medical Education Strategy, and Genentech observed in a session called Measuring Shared Decision-Making and Patient Engagement Practices in Health Systems, shared decision making, grounded in evidence-based practice, can also enrich patient-reported outcomes (PROs). For instance, shared decision making is known to improve quality of life and functional status, which in turn may result in increased treatment eligibility days.
"Patients who are more engaged in their health care decision making are more likely to experience confidence in and satisfaction with treatment decisions and increased trust in their providers." - Kane et al., 2014
How is SDM Helpful in Clinical Practice?
Effective SDM requires at least the following components:
Clear discussion about patient preferences and goals
Unbiased information on treatment risks and benefits that is tailored for individual patients
Support for adherence
Review of the side effect burden that patients are willing to bear
SDM is here to stay, but, as Sih-Meynier noted, shared decision making is hard to execute in practice at the moment. A recent qualitative study on communication in tumor gene expression tests shows this.
Moreover, SDM is often mapped to patient engagement. This term has been around for decades (since at least 1988). Still, patients don’t like it very much, as Sarah Krüg wryly pointed out in a session on The Patient-Centered Grant: A Systematic Review of Multi-Professional Grant Opportunities.
Krüg is the Executive Director of Cancer101 and the Acting Executive Director for the Society for Participatory Medicine, which recently examined how patients view terms such as engagement and SDM.
Due to patient wariness of how providers currently approach engaging them in medical decisions, implementing SDM can be hard. That's where CME can fill in a knowledge and strategy gap, giving health care providers better tools with which to empower their patients.
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Implementing Effective SDM Strategies
It is perhaps unsurprising that SDM is still not widely used in clinical practice. But change may be on the horizon. I was happy to learn about a range of tools that support SDM at the annual meeting of ACEHP, which CME/CPD providers can integrate with their programs and activities across disciplines and diseases.
A small sampling of these tools includes GURULZ™, a patient decision aid designed to reduce disparities in healthcare coverage by arming patients and healthcare providers with information about their coverage options to support real-time decision-making. Another is Prescription to Learn®, a personalized health GPS that Cancer101 has designed to guide patients with cancer through treatment decision-making.
CME/CPD programs that advance SDM include a digital health intervention created by CME Outfitters and Pack Health that informs and engages patients with psoriasis through education and support from a health coach. Outcomes evaluation showed clinical and behavioral changes resulting in better psoriasis management through evidence-based decisions.
And last but not least, in 2017 the National Quality Task Force marshaled 20 organizations to create a Shared Decision-Making Action Brief that promotes the value of SDM.
The Role of CME in Shared Decision-Making
How we educate our healthcare providers can play a big role in what gets implemented in clinical practice. CME materials and programs can help inform and transform the nature of patient-provider interactions through interactive workshops, case studies, and acting out clinical scenarios that integrate strategies from implementing shared decision making into patient's lives.
CME can also help clinicians better understand:
patient values and preferences
the value of communicating in plain language
how to include patients in informed decision making
skillful use of patient decision aids
the role of interdisciplinary collaboration in shared decision making
how shared decision making can integrate into the flow of patient and provider interaction
Shared decision making holds a lot of promise for better patient outcomes and for making healthcare feel more accessible and patient-centered. However, it starts with us - CME writers. I, for one, am glad to be a part of this positive change.
Now You Can Help Foster Shared Decision Making as a CME Writer
Shared decision-making makes health care easier to navigate and helps patients feel they have a real say in their treatment options and health outcomes. Implementation of this strategy in the patient and provider relationship can be difficult, and it starts with provider education. That's where continuing medical education writers come in. If you want to kickstart your freelance CME career, there's no better time to start.
Experience skillful coaching and compassionate mentorship as you move from clinical or academic to writer. Learn more about joining WriteCME Pro on the Write Medicine website today.
References
1. Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med 1997;44(5):681-692.
2. Kane HL, Halpern MT, Squiers LB, Treiman KA, McCormack LA. Implementing and evaluating shared decision-making in oncology practice. CA Cancer J Clin. 2014;64(6):377-388.
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