What is shared decision making?
In this blog, we are going to discuss the importance of shared decision making, the challenges and the studies around shared decision making. But first, let’s begin answering what shared decision making actually is. In this context, we are referring to shared decision making (SDM) in a healthcare environment.
SDM in healthcare is an approach that involves a collaborative process between healthcare providers and patients in making healthcare decisions. It recognised that patients have values, preferences and experiences that should be considered when making medical choices. SDM must ensure that the patient is well informed about the potential benefits, risks and alternatives of different treatment options, actively involving them in the decision making process.
Ideally, healthcare professionals provide patients with accurate and balanced information on their conditions, diagnosis, and available treatment options. They should clearly explain the potential benefits, risks and uncertainties with each option, as well as the likely outcomes and possible alternatives. The healthcare provider helps the patient understand the medical information by using clear and understandable language. If necessary, this can be aided with visuals or educational materials.
Throughout SDM, it’s also necessary for the patient to express their preferences, values, goals and realistic ability to reach these. If a patient can not be open or realistic with their ability to fulfil a treatment plan, it is very likely to have an unsuccessful outcome. However, when patients feel comfortable engaging in open and honest conversations with their nurse or doctor, it enables the setting of expectations and facilitates the discovery of practical solutions.
- Shared decision making improve patient satisfaction, increase knowledge about treatment options, enhance adherence to treatment plans, but also can potentially lead to better health outcomes.
- There are four main challenges when it comes to SDM. Time constraints, unequal power dynamics, cultural or language barriers, and information overload.
- Two studies explained below, prove the effectiveness of SDM on patient satisfaction and outcome.
- There are many doable strategies that can be implemented into university programs to continuously teach and assess students SDM.
- Both The Federation of Medical Specialists and NFK specifically leverage Videolab for shared decision making training.
Why is shared decision making important?
SDM recognises that healthcare decisions should be a partnership between the patients and doctor. It promotes patient autonomy and respects patients’ rights to actively participate in decisions about their own health. This approach ensures that individuals receive support and encouragement to make decisions that are best suited to them.
Not only does SDM improve patient satisfaction, increase knowledge about treatment options, enhance adherence to treatment plans, but also can potentially lead to better health outcomes. It can be particularly valuable in situations where multiple treatment options exist, and the best choice depends on the individual patient factors, such as personal preferences or the presence of other possible illnesses.
A study done by eight researchers (referenced here) based in various medical departments and universities in The Netherlands goes into the effects of applying shared decision making on treatment of breast cancer patients.
The study took clinicians from similar backgrounds and education, five breast cancer outpatients clinics, and approximately 50 patients to participate. The research team asked each hospital team to audio record 15 decision-making processes with patients before and after implementing a multilevel program. The consultation characteristics involved presenting all treatment options to patients and involving them more in the conversation of their welfare. Clinicians handling consultations were training in various SDM, group meetings, feedback meetings, and other courses. After a total of 112 recorded consultations, the study found that a theory-based multilevel SDM implementation program, developed in collaboration with patients and clinicians, led to a significant and meaningful improvement in SDM management. Although it required a reasonable time commitment from clinicians, the research team, and patient representatives, the program did not result in long-term adverse effects such as increased consultation time.
Tailoring the program to address both team-level challenges and individual clinician needs proved effective. Elements such as feedback discussions, re-evaluation and redistributing of tasks help the process along the way.
Another paper written in 2021 by five researchers (referenced here), looks into when shared decision-making should be more patient driven, and when it should be more provider driven. Examining interesting factors such as what a patient may need at a certain point in time. Depending on a patient’s personality traits, emotional arousal, motivation, and health state, a healthcare provider should choose the correct approach to discuss a health plan or treatment plan.
The results found through the empirical evidence and theoretical perspectives, that there should be more flexibility with the delivery of SDM. It implies that although prioritising the patient’s needs should be the focus of all SDM, it does not always have to be solely driven by the patient. In certain situations, a more provider-driven approach may be more practical, ethical, and effective.
Further research is required to investigate whether aligning decision-making behaviour with patients’ states and traits is more effective compared to providing all patients with the same type of decision-making power, as stated in the study.
This is where communication, empathic accuracy, compassion, and emotional intelligence training comes into play. Healthcare providers should learn these skills to read their patient, and adapt the shared decision making strategy.
Challenges in shared decision making in healthcare
As outlined above, achieving SDM poses several challenges that need to be addressed. For example:
- Time constraints: SDM requires adequate time for doctors and patients to engage in conversations and build trust. Limited time can be caused by high patient volumes and therefore impact a full exploration of treatment options and feedback loops with patients.
- Unequal power dynamics: power imbalances can occur between doctor and patient, which can influence the shared decision making. Patients may feel intimidated or hesitant to voice their preferences or questions to their doctors. This leads to lack of true collaboration.
- Cultural and language barriers: it is crucial to consider cultural and language situations between both parties. The need for interpretation services may be necessary to ensure that patients fully understand their options and can express their view.
- Information overload: A patient may experience overwhelming feelings when attempting to comprehend and consider an excessive amount of information, particularly when complex medical terminology is utilised. It is important a doctor goes through information at a comfortable speed and language so that patients understand and have the opportunity to ask questions.
Addressing these challenges requires extensive training in communication and soft skills, the development of patient-centred care, health literacy initiatives and fostering a supportive healthcare environment that values patient engagement and participation.
How to implement shared decision making
- Establish a supportive environment: create an atmosphere that encourages open communication, trust and mutual respect between doctor and patient.
- Invite the patient to participate: inviting patients to participate through questions allows them to voice their opinions at an early stage, helping build trust.
- Present options: patients need to be aware of the whole process that has occurred before presenting diagnosis and treatment options. Explain this process to them.
- Provide information on benefits and risks: Share impartial information from existing scientific evidence. Follow up with patients to ensure their understanding of the provided information.
- Assist patients in evaluating options: Help patients assess their options by considering their goals and concerns. Inquire about what matters most to patients and what worries them to gain insights into their preferences.
- Facilitate deliberation and decision making: Let the patients know they have time to think things over. Ask patients if there is any additional information or action they require before they can confidently make a decision.
- Support patients in implementing their decision: outline the subsequent actions they need to take. Confirm their comprehension and address any potential obstacles they may encounter while executing the decision.
- Follow-up and reassess: Regularly revisit the treatment decision to assess its effectiveness and make adjustments if necessary. Continuously engage in open communication with the patient to address any concerns, monitor progress, and make SDM regarding ongoing care.
*source: National Learning Consortium. Shared Decision Making Fact Sheet. (2013)
How can Videolab help shared decision making?
Videolab accesses a new innovation towards healthcare and MedTech. Proven to improve communication skills in clinical settings (source), Videolab helps students reflect on their performance through multiple feedback mechanisms.
Videolab is a privacy compliant video sharing platform which allows students and doctors to record their consultations for reflection. When uploading the consultation recording onto Videolab, Videolab encrypts the recording and ensures that any copies are destroyed.
Users can provide feedback and evaluations on specific time fragments or the whole video. This is done through using structured evaluation methods according to defined evaluation methods. All the measures are out in place for patient interactions training to be easy, efficient and secure.
Videolab helps shared decision making through different forms of reflection and aids of communication training. Students are able to analyse whether they properly communicated to patients and how they helped a patient feel included in their health consultation.
Both The Federation of Medical Specialists and NFK specifically leverage Videolab for shared decision making training. These two organisations are highly respected in The Netherlands for their efforts to use innovative tools for improved learning and training of both students and doctors.
Shared decision-making is a vital component of patient-centred care, empowering individuals to actively participate in their healthcare decisions. By embracing this collaborative approach, healthcare systems can improve patient outcomes and enhance patient satisfaction. Subsequently building stronger relationships between patients and providers. It is imperative for healthcare organisations and professionals to prioritise and invest in shared decision making to truly achieve patient-centred care and transform the healthcare landscape for the better.
And what better to improve shared decision making than with Videolab?