It takes 2 to Tango: Dancing to the Tune of Shared Decision-Making

Favorite Alliance Sessions

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), which has become something of a buzzword in healthcare. SDM is increasingly recognized as part of value-based care and reimbursement, but it has been advocated as an ideal model of treatment negotiation in medical encounters since at least 1997.

What is SDM?

The concept is riven with myriad meanings, but an early attempt at definition outlined the following characteristics of SDM:1

  • SDM should include at least two participants (provider and patient); and each party should:
  • Share information
  • Try to build consensus about treatment
  • Reach an agreement on which treatment to implement.

In short, SDM is a two-way process of communication that involves clinicians and patients working together to achieve a common aim. Recent scholarship emphasizes that effective SDM in oncology can lead to better outcomes, improve treatment adherence, reduce care variations, and enhance satisfaction. As Regina Sih-Meynier, Group Management, Medical Education Strategy, Genentech observed in a session titled Measuring Shared Decision-Making and Patient Engagement Practices in Health Systems, SDM can also enrich patient-reported outcomes (PROs). For instance, SDM is known to improve quality of life and functional status, which in turn may result in increased treatment eligibility days.

Effective SDM

But effective SDM requires at least the following components:2

  • Clear discussion about patient preferences and goals;
  • Unbiased information on treatment risks and benefits that is tailored for individual patients;
  • Support for adherence; and
  • Review of the side effect burden that patients are willing to bear.

SDM is here to stay, but, as Sih-Meynier noted, in practice SDM is hard to execute in the moment—as shown by this recent qualitative study on communication in tumor gene expression tests.

Moreover, SDM is often mapped to patient engagement—another term that has been around for decades (since at least 1988), but that patients don’t actually like 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 Executive Director of Cancer101 and the Acting Executive Director for the Society for Participatory Medicine, which recently examined how patients view terms such and engagement and SDM.

Unsurprisingly, then, SDM is still not widely adopted in clinical practice.

Tools for SDM

That’s why it was exciting to learn at the Alliance about a range of tools that support SDM, and that CME/CPD providers can integrate with their programs and activities across disciplines and diseases. A small sampling of these tools includes the following:

GURULZ™ is a decision support tool 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.

Prescription to Learn® is 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 informed and engaged patients with psoriasis through education and support from a health coach. Outcomes evaluation showed both clinical and behavioral changes that resulted in better psoriasis management.

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. In 2018, it will publish an SDM Playbook that provides strategies for adopting SDM in practice—such as using evidence-based decision aids.

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.