What is shared decision-making?

Part of the challenge in providing value-based, quality healthcare to patients is having those patients follow care instructions, fill their prescriptions, and properly follow the primary care physician’s directives for additional tests or treatment. Human nature is such that we like to have input into decisions that affect our future. When patients have a part in the medical decision-making process, they are more likely to become engaged in their own healthcare.

Shared-decision making is just that. The primary care physician and the patient collaborate to make those decisions that impact the patient, including determining which tests to undergo, deciding on an effective and sensible treatment plan, and determining which medications will work best for the patient, based on the patient’s lifestyle and willingness to follow up on those decisions. These decisions must, of course, be “based on clinical evidence that balances risks and expected outcomes with patient preferences and values,” as described by Health IT’s National Learning Consortium.

The Consortium has found that when patients participate in the shared decision process, they are more engaged and that results in patients:

• learning about their health and understanding their health conditions
• recognizing that a decision needs to be made and are informed about the options
• understanding the pros and cons of different options
• having the information and tools needed to evaluate their options
• being better prepared to talk with their health care provider
• collaborating with their health care team to make a decision right for them
• being more likely to follow through on their decision

The Agency for Healthcare Research and Quality (AHRQ) offers the SHARE approach for the primary care physician to actively engage the patient in shared-decision making:

Step 1: Seek your patient’s participation.

Step 2: Help your patient explore and compare treatment options.

Step 3: Assess your patient’s values and preferences.

Step 4: Reach a decision with your patient.

Step 5: Evaluate your patient’s decision.

Electronic health records (EHRs) can assist in the shared-decision making process as well. Patient portals and secure electronic messaging allow the primary care physician and the patient to communicate securely, so the patient feels free to ask questions, to seek clarification, and to provide input on healthcare decisions.