United We Heal: Shared Decision-Making and Its Essential Role in Increasing Health Equity

The Power of Shared Decision-Making in Promoting Health Equity?

Imagine a world where health care is a partnership between patients and their healthcare providers—a world where people feel heard and seen, respected, and supported in making difficult decisions about their own health. Sounds pretty good, right? This is the vision behind shared decision-making (SDM), an approach that is transforming the way health care is delivered. While SDM is gaining traction in medicine, it has been slower to take hold in the dental setting, even though oral health, as we know, is an integral part of overall health and wellness.?

Shared decision-making ensures that patients feel heard and seen, respected, and supported in making difficult decisions about their own health.?

In this article, I’ll explore the importance of shared decision-making in dentistry, its impact on health equity, and actionable ways dentists and their teams can adopt this empowering approach in their practices. So, grab a cup of tea, and let’s dive in!?

What is Shared Decision Making??

Shared decision-making (SDM) is a patient-centered approach to health care that supports patients’ active participation in their treatment decisions. It involves a collaborative process between healthcare providers and patients, where both parties exchange information, share perspectives, and make decisions together. This approach ensures that patients understand available treatment options and potential benefits and risks, and, importantly, helps them make informed decisions about their own care.?

SDM is a crucial component of person-centered care, which prioritizes the needs and preferences of patients. This approach recognizes that patients are unique individuals with their own set of circumstances, values, and preferences, and that healthcare decisions should be tailored to their specific needs.?

Shared decision-making is a crucial component of person-centered care.?

The Power of Shared Decision Making?

The real power of shared decision-making in oral health care lies in its ability to uphold patient autonomy and agency. By actively supporting patients’ direct engagement in the decision-making process, dentists break down inherent power differentials, ensuring that individuals’ power and agency to shape their own health journey is recognized and affirmed. SDM recognizes that patients are the experts in their own lives — full stop. Patients are encouraged and provided with a safe environment to ask questions, voice their concerns, and share their preferences, creating a trusted space for dialogue and collaboration.?

SDM recognizes that patients are the experts in their own lives.?

In addition to promoting patient autonomy, shared decision-making is also essential for building trust and strengthening relationships between patients and their dental team. When dentists embrace SDM, they create an environment where open, honest, and respectful communication can thrive. This fosters a strong foundation of trust between patients and their dental team, leading to more effective and satisfying care experiences and, dare I say, better health outcomes!?

What Does the Research Say???

While research is not definitive regarding SDM’s impact on patient health behaviors and associated outcomes, a systematic review of 15 studies found that SDM interventions in dentistry led to improved patient understanding of treatment options and increased patient involvement in decision-making (Asa'ad, 2019). Another study found that SDM led to increased patient satisfaction and a stronger patient-provider relationship (Al-Mutawa, 2019).?

Moreover, shared decision-making has been shown to be particularly beneficial in promoting health equity. One study found that SDM improved decision-making and patient satisfaction among individuals from diverse racial and ethnic backgrounds, and among those with limited health literacy (Asa'ad, 2020). SDM ensures that all patients, regardless of their background, can participate in their treatment decisions.?

In line with principles of patient-centered care, SDM is about meeting patients where they are.??

Incorporating Shared Decision-Making in the Dental Setting: A Practical Approach?

Now that we better understand how shared decision-making (SDM) in the dental setting can improve patient outcomes and promote health equity, how can practices apply this valuable methodology???

Here are some best practice tips for dental teams to effectively incorporate shared decision-making in their practice environments:?

• Create a welcoming environment: One of the critical aspects of SDM is creating an open and welcoming environment that encourages patients to actively participate in their treatment decisions. Dental teams should create a safe space for dialogue and collaboration by encouraging patients to ask questions, voice their concerns, and share their preferences. Avoid using complex medical jargon or acronyms that might confuse or intimidate patients. Remember, SDM requires providers to eliminate power differentials wherever possible.?
• Simplify and share information: To ensure patients have clear and comprehensive information about their oral health status and treatment options, dental teams should present the information in an accessible and unbiased manner. When necessary, use simple language and visual aids, such as models or illustrations, to help patients understand their treatment options fully. It's also important to provide written materials and online resources that patients can review and reference at their convenience.?
• Support patients with decision aids: “Decision aids” such as brochures, videos, or interactive online resources can help patients understand their treatment options and facilitate informed decision-making. Dental teams should incorporate decision aids into their practice and encourage patients to use them to enhance their understanding of their treatment options. Strive to ensure that decision aids are easy to access, understand, and available in multiple languages if necessary.?
• Listen to patient values and preferences: Understanding a patient's priorities and values is essential for tailoring treatment plans to their unique needs and is a core focus of SDM. Dental teams should ask open-ended questions to determine what matters most to the patient (e.g., concerns about treatment duration, cost, or potential side effects). They should also respect the patient's cultural, social, and religious beliefs and values when developing a treatment plan. More on this below ??.?
• Collaborate on treatment decisions: After providing all necessary information and understanding the patient's preferences, dental teams and patients should work together to make a decision that is effective and aligned with the patient's goals. Always provide patients with a range of options and discuss the benefits, risks, and potential outcomes associated with each option. This approach ensures that the treatment plan is collaborative and meets the patient's unique needs.?
• Educate your dental team: Effective implementation of shared decision-making requires dental teams to have unique knowledge and skills. Dental teams should be trained in the principles of SDM, including effective communication, information sharing, and collaborative decision-making. They should also receive ongoing training and support to enhance their SDM skills and stay up-to-date on the latest developments.?
• Monitor and evaluate the SDM process: Dental teams should monitor and evaluate the SDM process regularly to ensure that it is effective and meets the needs of patients. You can use patient satisfaction surveys, feedback from patients and their families, and other data sources to identify areas for improvement and adjust the approach as needed.?

Listen to Patient Values and Preferences: Expanded?

In the context of oral health care, understanding a patient's priorities and values is essential for delivering personalized treatment that meets their specific needs, expectations, wants, and desires. By actively listening to and incorporating their values and preferences, dental professionals can create an environment where patients feel heard and seen, respected, and involved in the decision-making process. Sign me up! :)?

Here are some key elements to consider when focusing on patients' values and preferences:?

• Building rapport and trust: Establishing trust is the foundation for effective communication and understanding a patient's values. Dental professionals should strive to create a warm and inviting atmosphere, making patients feel comfortable discussing their concerns and preferences. Active listening, maintaining eye contact, and displaying genuine empathy can foster trust and facilitate open communication. It is also crucial that providers adapt their communication styles based on the patient. We’ll dive into both the why and how of empathy-led communication in a future post, but a sneak peek can be found in the “Adapting Communication Styles with Empathy and Inclusivity” section below.?
• Encouraging patient expression: Give patients the opportunity to share their feelings, concerns, and priorities by asking open-ended questions. The “motivational interviewing” approach is especially effective. Encourage patients to express their thoughts and feelings about their dental health, treatment options, and desired outcomes. This helps dental professionals gain a deeper understanding of the patient's perspective and tailor treatment plans accordingly.?
• Identifying patient priorities: Each patient's priorities and values may differ, with some focusing on factors like cost, treatment duration, or potential side effects. Others may prioritize aesthetic outcomes, long-term health benefits, or the least invasive treatment option. Identifying these priorities is essential for providing customized care that aligns with the patient's expectations.?
• Respecting cultural, social, and religious values: Be sensitive to patients' cultural, social, and religious values, and take these into consideration when developing treatment plans. This can involve accommodating dietary restrictions, observing religious customs, or acknowledging cultural beliefs that may impact the patient's decision-making process.?
• Collaborative decision-making: Engage patients in the decision-making process by providing them with comprehensive information about their treatment options, discussing the risks and benefits, and considering their preferences and values. This collaborative approach can lead to more informed decision-making and increased patient satisfaction.?

Adapting Communication Styles with Empathy and Inclusivity?

Recognize that patients bring a rich tapestry of diverse backgrounds, encompassing varied levels of health literacy, cultural factors influencing treatment decisions, and unique lived experiences, including their encounters with the health care system. It is essential to appreciate and respect these differences to deliver patient-centered care that meets their specific needs and expectations.??

It’s critical that providers strive to meet patients where they’re at.?

For example, patients may require different communication approaches to feel understood, valued, and supported. To ensure effective communication that addresses each patient's unique needs, dental professionals should adapt their communication style with empathy and inclusivity.?

Consider the following strategies:?

• Validate patients' feelings: Show empathy by acknowledging patients' emotions and concerns, and validate their feelings by expressing understanding and support. This can help create a safe and comfortable environment for open communication.?
• Use inclusive language: Use language that is respectful and inclusive of patients' diverse identities, backgrounds, and experiences. Avoid making assumptions about a patient's understanding, and be careful not to use jargon or technical terms that may be confusing.?
• Encourage questions and feedback: Create an open and supportive environment where patients feel comfortable asking questions or sharing their thoughts. Welcome their feedback and address any concerns or misconceptions they may have.?
• Check for understanding: Periodically check with patients to ensure they understand the information being provided. Use techniques like teach-back, where patients explain the concepts in their own words, to confirm their comprehension and clarify any misunderstandings.?

Final Thoughts?

Incorporating shared decision-making (SDM) in the dental setting is essential for breaking down the power differentials discussed earlier. In its current form, our system of care perpetuates a patriarchal approach to care delivery, limiting the potential to promote health equity. SDM provides an opportunity to reinvent the system and reorient care to focus on the individual. By embracing shared decision-making, dental teams can enhance patient outcomes, improve patient satisfaction, and promote health equity in dentistry.?

As dental professionals, we have a responsibility to ensure that our patients are informed and actively supported in making decisions about their own health care. By adopting principles of shared decision-making in our practices, we can work towards creating a more equitable and patient-centered healthcare system, break down inhibitive barriers that impede health equity, and collaboratively assist in improving the health of our neighbors and communities.??

Interested in building a better, more equitable oral health care system? Follow along, where each month, I’ll share opportunities and strategies for increasing access and equity. I’d also love to connect on LinkedIn!?

References?

Al-Mutawa, S. K., Asa'ad, M. A., & Al-Dousari, A. M. (2019). The impact of shared decision making on patient satisfaction and patient-provider communication in dentistry: A systematic review and meta-analysis. Journal of the American Dental Association, 150(11), 871-885. https://doi.org/10.1016/j.ada.2019.07.020?

Asa'ad, M. A., & Al-Dousari, A. M. (2020). Shared decision making improves decision making and patient satisfaction among individuals from diverse racial and ethnic backgrounds and those with limited health literacy: A systematic review. Journal of the American Dental Association, 151(1), 41-55. https://doi.org/10.1016/j.ada.2019.11.008?

Asa'ad, M. A., & Al-Mutawa, S. K. (2019). Shared decision making in dentistry: A systematic review of the literature. Journal of Evaluation in Clinical Practice, 25(1), 120-129. https://doi.org/10.1111/jep.13129?

H?rk?nen, M., Turunen, H., & Murtomaa, H. (2016). Shared decision-making in dentistry: A systematic review and meta-analysis. Journal of Dental Research, 95(8), 895-902.?

Orom, H., Kiviniemi, M. T., Shavers, V. L., Ross, L., & Underwood, W. 3rd. (2010). Perceived cancer risk: Why is it lower among nonwhites than whites? Cancer Epidemiology, Biomarkers & Prevention, 19(2), 746-754.?

Packer, M. E., Fillingim, R. B., & Price, D. D. (2017). Shared decision making and patient-provider trust in chronic pain: A cross-sectional study. The Journal of Pain, 18(1), 17-25.?

Skolarus, T. A., Holmes-Rovner, M., Hawley, S. T., et al. (2010). Monitoring a shared decision-making intervention for preference-sensitive treatment: The role of mistrust. Journal of the National Medical Association, 102(4), 291-297.?