Shared Decision-Making FAQ
1. How is shared decision-making different from informed consent?
Shared decision-making is a process of using medical evidence and the patient’s personal values to come to a decision about a course of treatment. The process happens before a decision is made and allows patients to reconsider the decision over time. The ongoing relationship between patient and clinician is part of the process.
Informed consent is a discrete act. The patient’s signature confirms that the patient understands and agrees to the intervention; signing take place right before the intervention occurs.
Imagine you are buying a home. Shared decision-making is like your interactions with the realtor as you decide which house to buy. Informed consent is like the closing where you sign off on the purchase.
2. Everyone already thinks we use shared decision-making. How should I deal with this?
Start by bringing people together to discuss the available treatment options for a given condition. By identifying options and clarifying what information patients need to make a decision, we often expose the variable messages that patients hear. This can be a good starting point for a discussion on how to improve the conversation.
Or, begin with a survey of patients to see if they recall hearing their options, or whether they understood key facts about their decision. This can offer compelling evidence that clinicians are not communicating important information as well as they think.
3. What is the evidence behind shared decision-making?
Over 100 studies show that decision support tools can improve patient knowledge and give them greater confidence in the decisions they make.
We need to better understand how to implement these tools; however, keep in mind that this dilemma occurs in other areas of medical practice as well: Evidence may show that an intervention is effective, but it often takes time and effort to apply that knowledge to improving the lives of patients. >> Related: 19 Key shared decision-making articles
4. What if patients don’t want shared decision-making?
We have responsibilities to offer patients the necessary information about their treatment and to listen to what is important to them when making the decision. If, ultimately, they defer their decision to their provider, that is their choice. We respect their desire to rely on the clinician’s judgment.
5. What is the business case for shared-decision-making? Are there any cost savings?
The business case usually relates to the goal of patient-centered care, a central part of the overall strategic plan for most organizations. A primary measure of success is the degree to which patients experience high-quality care. In this context, the fundamental values of shared decision-making—respecting patients and listening to what is important to them—are sound business practices.
Certainly, shared decision-making can reduce the unnecessary use of health care resources. Some interventions are overused; patients are less likely to use them when they’re given the option of saying no. Nevertheless, we must be careful to keep our focus on the ultimate goals of shared decision-making—respecting patient preferences and making sure patients are well informed.
6. We don’t have time for these conversations. How can we streamline the shared decision-making process?
As many studies show, we can incorporate decision support strategies into patient encounters with minimal increase in time. A conversation between patient and clinician is already taking place; shared decision-making simply changes the nature of that conversation.
For patients, most encounters consist of a flow of difficult-to-understand information followed by a short period of time in which to make a decision.
Decision aids can communicate some of the information more efficiently, allowing patients to digest the important facts prior to the visit. This changes the visit into a discussion where patients feel more comfortable expressing what is important to them—with the confidence that comes with having a better understanding of the information.
7. Do I need to add staff?
No, you do not need to add staff or a lot of other resources to implement shared decision-making.
Look at your processes to see the best ways to incorporate shared decision-making into existing work flows. Small changes in the timing and nature of information delivery can make a big difference. Decision aids are designed to make interacting with patients easier or to help the patients do some of the work on their own, at their own pace.
8. What should I do if senior leadership is not making this a priority?
This could be a significant barrier. Try to engage leadership in a discussion about how shared decision-making aligns with your organization’s mission and vision. Appeal to the fact that this is the right thing to do for patients.
You might also demonstrate the effectiveness of this intervention in small pilots that use few resources and have a minimal impact on the organization. By carefully collecting data from these pilots and bringing back stories of lessons learned and positive outcomes, you can make the case for further adoption of shared decision-making.
9. I need a speaker. Who do I contact?
The MSDMC can help you find someone. Many members of the collaborative have experienced speakers who can help with education. >> Contact
10. How can we educate patients about shared decision-making?
There has been some work on helping patients gain a better understanding of shared decision-making, but this area needs further exploration. The collaborative will be identifying some patient resources that will be added to the site in the next phase of development.
11. Who are the experts in this area?
Researchers around the world are exploring the best ways to make shared decision-making a practical reality for patients and clinicians. We are fortunate to have some of those experts here in our community. Here are links to various organizations that are leaders in the field. >> Related: Links to other shared decision-making sites.