Patient-Centered Care at its Finest: SDM
'Shared Decision-Making' (SDM) is an approach that involves patients and providers in working together to make health care decisions that are based on clinical best practices and aligned with patient preferences and values.
There is a lack of communication between patients and providers within health care teams.
Improved patient satisfaction, clearer communication of risk, improved health literacy, more accurate decisions, fewer unnecessary treatments, healthier lifestyles, improved confidence and self-efficacy, safer care, greater compliance with ethical standards, and lower costs are all potential benefits of SDM.
No matter how compelling the clinical evidence may be, a health care system should never provide care that is worthless to its patients.
As each patient will have specific needs in terms of information and support, it is very important not to make decisions for them without involving them. A variety of factors affect the way we live, including our work and income, as well as our access to critical health literacy skills that can help mitigate adverse social determinants. By addressing social determinants of health, interventions can be made to enhance health literacy. Scientists proposed the use of SDM to reduce health care disparities through designing materials that would assist people who have less literacy or socioeconomic status in making decisions about their health care.
For many patients, the time spent meeting with their physician is the most opportune moment for them to become engaged in their own health through the process of shared decision-making. Although little is known about the extent to which physicians facilitate patient involvement throughout the decision-making process, and the nature and extent to which informed decision-making occurs, especially in routine office visits for both primary care physicians and surgeons.
No decision about me, without me.
SDM is an interpersonal process where providers and patients collaborate to make decisions using the best available evidence and patient preferences and lived experiences. Every patient should be as actively involved in making decisions about their health and healthcare as they wish to be. One of the main purposes of giving patients more say in decisions about their care and treatment is to deliver greater equity.
Poor SDM was associated with worse patient-reported health outcomes, worse established quality indicators, and higher healthcare utilization.
The patient voice can be included in the decision-making by focusing primarily on Communication, System Design, Clinical Appropriateness, and Time.
By improving communication between the patient and the provider, transitions in care will become smoother, relationships will be richer, and in turn, SDM will be a more foundational concept. When it comes to clinical appropriateness, there is a conflict between provider values and knowledge, and the patient values in determining what is appropriate. Patient values have a role in determining appropriateness in SDM.
In addition to developing decision support systems to include patient preferences in clinical decision-making, medical informatics can play a major role in improving patient-centered care. A system-wide approach is needed to support patients and health care providers, as well as to develop health care provider skills and improve patient health literacy. However, this is not an easy task, as it would require the integration of knowledge from four major research areas:
System Designs are not proactive and flexible, they lack provider education and tools to build skills, and there isn't sufficient time to build relationships and trust. The demand for patient engagement and patient-centered care is growing, along with the development of SDM tools, training, policies, and incentives to encourage SDM (e.g., the Affordable Care Act provisions to encourage SDM).
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Identifying and understanding the features, values, resources, and priorities of various target audiences at multiple levels is vital, including leaders of health care organizations (and guidelines for doing so), clinicians and health care teams, policy and financial issues, as well as patients and their families.
Research shows that there is a strong need for further Awareness, Training, and Funding/Reimbursement tools to be developed for clinicians to use to help describe to patients the benefits, risks, harms, and costs of various treatments.
Shared decision-making involves practitioners presenting and explaining options to patients, the latter using the information to develop preferences according to their priorities and values, and the two parties ultimately negotiating a final decision together. Patient involvement in health care is recognized to improve outcomes and reduce unnecessary health care investigation and practice variations through shared decision-making.
To conclude, patients and healthcare professionals can make health-related decisions together, as partners, by evaluating all available healthcare options and weighing personal values and preferences against available unbiased evidence.
Sources & Further Reading:
Oxford Academic - Health literacy and the social determinants of health: a qualitative model from adult learners
NHS England - Shared Decision Making / Liberating the NHS
AJS - Association of shared decision-making on patient-reported health outcomes and healthcare utilization
Significant experience advancing patient-centric digital innovation and transformation in the healthcare industry
2 年Great and important article!