What are the best ways to help physicians understand shared decision making?

We already know it. Our care is already patient-centric. Who wrote this? Patients already participate in decision making. This is what we do!!!

As a Medicare regulatory expert, I will point out that there is shared decision-making (which is called good practice of medicine) and then there is "shared decision-making." For patients with Medicare who are planned for a left atrial appendage closure device, a carotic artery stent or an ICD for primary prevention, a formal shared decision making visit must occur and be documented. For ICD and LAA, the visit must use a validated tool. For carotid stent, there is not yet any validated tool so the physician must explain the risks/benefits, guideline recommendations and allow the patient to share in choosing the course to follow. I will note that Medicare is auditing for the presence of this visit and it's a sure denial if not present.

I think the comments point out that there isn't a good understanding of what SDM truly is. Many doctors think it means sharing a bunch of facts around the issue and having the patient decide what they want. However, patients will rarely have as full of an understanding of the issue as the physician, so I think the approach is the opposite. The physician needs to ask questions to understand the patient's values, aspirations and expectations. They then would make the recommendation that they would choose if they were approaching the decision, given all of their clinical knowledge and experience, but through the perspective of that patient. Explaining to the patient why that approach considers what's important to them is empowering.

It is truly plain and simple. Imagine that as a physician you went to see your doctor because you were not feeling well and they found you had a serious condition that required treatment, but instead of sitting down and discussing your options, they decided the treatment plan for you. You had no input, no discussion. How happy and compliant would you be with this? The best way to think about this is to put yourself in your patient’s shoes. Discuss their condition with them in plain language. Provide options. When your patient comes to a decision, support it and reassure your patient about their decision. This is the best way to maintain positive outlooks and communication.

The term shared decision making may seem new but at its core this is something we as physicians have always done. We involve patients, their care givers and other healthcare providers to collaborate in discussing treatment options. This process benefits patients by fostering deeper understanding into their disease process and treatment choices leading to increased satisfaction and better health outcomes.

"training can include workshops, webinars, coaching, or peer learning, that can teach physicians the principles, skills, and steps of SDM, such as eliciting patient preferences, presenting options, discussing pros and cons, and reaching a consensus." Nothing like taking the time away that physicians have for actually looking after patients. Physicians are already trained in the art of managing and engaging patients.

As physicians, continuous learning is key. We can always improve the way we communicate with patients. Its on us to foster a collaborative environment where patients feel comfortable expressing their concerns, values, and preferences. Actively listen, validate their perspectives, and involve them in the decision-making process. Together, we can make informed choices that align with their unique needs.

In my opinion and in practice as a PA I have always spent the time to listen to patients concerns and address any questions. The majority of people who practice medicine want to help humanity and already know all of this inherently without any need for specialized training. The issue is lack of time and the corporatizing of the medical field. When medicine is run as a business and patients are treated as consumers a conflict of interest is created that demoralizes all parties.

Trainings are very important and become more effective when provided by a fellow physician and include role plays. The duration of the training needs to be well coordinated and managed to ensure participation of the physicians.

As well esteemed colleague, alluded to, most, if not all, of this kind of training is an ongoing phenomenon. In the residency training that we undergo, we do lot of what is talked about here and even more. What’s interesting is that the training we do as residents - takes place under the experienced eyes of well seasoned attending physicians. We are critiqued and groomed by attending physicians to become better future clinicians and doctors with the perspective that we are lifelong learners. As such, physicians are groomed to deliver optimal patient centric care and imbued with the understanding that their lifelong learners who look out for the best in patient care.

Shared decision-making between physicians and patients already happens. Who wrote this? The only challenges are the mountains of bureaucracy that force physicians to sit at keyboards for hours performing data entry and take them away from patient care.

Payors pose a huge challenge to SDM, many times they won't approve a procedure, medication, therapy, rehab placement, reference to a subspecialist, and at times even a DME that was the outcome of an SDM, We need to bring in Payor in real-time for physician and patients to have a meaningful SDM. Hopefully, there are tech enabled platforms where all three parties can participate in SDM, this will also enhance the transparency for the patient and they will know the challenges and barriers to their care delivery.

Lack of time is one of the major issues faced by doctors in India. This is mainly to the issue of doctor patient ratio and the distribution of doctors mainly in the urban areas. This is a major issue for SDM in India.

As already stated, true SDM is very time-consuming and requires the use of validated tools and very significant patient focus ahead of time on important issues in order to have a productive conversation. As a medical oncologist, these are hard and long conversations that must take a very large amount of factors into consideration. Patient factors always matter. I have found on average it takes 2-3 hours to understand all the cultural, religious, and SDOH barriers and issues that go into establishing a treatment plan with best outcomes—and I excel at this topic. It is not easy. It takes time. And again, using validated tools and asking patients to think about certain topics ahead of time, using tools to capture thoughts, is critical.

Physician Assistants can be very helpful with this aspect as a physician can delegate this aspect of care to a trusted PA that has been educated regarding and aligns with that particular physicians treating philosophy.

"A fourth way to help physicians understand SDM is to model and promote this approach in your own interactions with them, whether you are a colleague, a manager, a trainer, or a consultant" Bingo. Bring in all the people who are not nurses or doctors to interfere with the delivery of healthcare. Physicians already practice shared-decision making with patients and families. Anyone who thinks otherwise has never been a patient.

Even the weakest team can outperform an individual. Remind the team of a time when they gained consensus on a decision and how well it worked out as a result.

The understanding and implementation of SDM should be a dynamic one that meds to be updated as different scenarios emerge or on basis to the experience of health professionals from previous encounters with patients and peers

I often recommend to regularly assess the effectiveness of shared decision-making practices. Seek feedback from patients and colleagues to identify areas for improvement. We should always strive for continuous growth and refinement in our approach.

Always believe that patients satisfaction and outcomes will dictate the effectiveness or SDM. This is the way we approach the learning process and improvement of a new initiative.

I pride myself on respecting what used to be called “patient autonomy”. Patient autonomy has now been changed to SDM to rope the physician in medicolegally. True shared decision making is a physician educating the patient to the best of their ability (or referring to someone who can) and allowing them (the patient) to make a decision about their care. In a perfect world, there would be no legal consequence to the physician if a patient “chooses poorly” (or is non-compliant). Unfortunately, that is not the case and more and more physicians are cherry-picking patients to avoid problems caused by “shared decision making”.

Have a health educator program that delineates the way to transmit the information to patients in other that becomes easy to understand and use at their level. The bottom line is make accessible to everyone

The Shared Decision Making approach can help me in making informed decisions in collaboration with my healthcare providers and coaches. This promotes my active participation, enhances my health literacy, and enables a better handling of the challenges in the digital health landscape. ??????

Chat with your patients like you're having a real conversation, using open ended questions and really listening to what they say. Make sure they feel comfy asking anything and know you're there to help. And remember, everyone's different, so keep it personal and make sure they know you get where they're coming from.

Full Agreement. Prof. Dr. George Grant Ph.D. IMD DHS Thanks for connecting and collaborating. Book.academyofwellness.com a zoom session soon.

In my experience it can be helpful to start small. Using the process of co-creation of plans with patients to navigate constraints identified in executing care plans provides a "baby-step" approach that further enhances trust and empathy in ways that subsequently make SDM easier.

When the patient is at the center of care, shared decision making makes the most sense. There's also studies showing the benefit of collaboration in patients outcomes. No matter how educated and experienced we are, we still don't know everything. There's value in another experts perspective and insights. Medicine and patient care is a team sport.

Shared decision making must start with patient autonomy. We must always remember, that the patient has the right to make the final decision. As physicians, we must empower our patients to make the best decisions possible so it is our job to provide suitable options and alternatives, as well as explain risks and benefits. What may seem like the best choice to us as their physician, may not be what is motivating the patient’s choice. Understanding the patient’s priorities can make shared decision, making more effective. This means you’re making the best choice for the patient, not just a medical condition . This means including discussions about cost, time-commitment, side effect profile, and acceptability of therapies.

When I read through this article, the thought of shared governance in an organization would be beneficial to patients and providers in shared decision making. At times, the questions of why and how expressed by a patient may encompass the actual administrative parts of the patient-provider experience. Including physicians in governance gives them a voice and insight into operational issues that may affect their practice.

A missing category is real time decision support for physicians, ideally embedded in the EMR. Having at hand visual and written materials to share with patients makes the conversation much easier.

??Physicians & other providers understand shared decision making. ?The better question is, “how can we improve it & increase its use?” ?? Assuring patient education tailored to individual health literacy levels, ensuring cultural humility, & using decision aids help. ???To improve shared decision-making, there needs to be therapeutic communication ??Communicating in a compassionate & understanding way helps patients feel more comfortable in sharing with their healthcare team….. ….. ……? BUT without allocating sufficient time for patient-provider interactions to actively involve patients all the tools & tips won’t work.