{"id":1841,"date":"2017-01-30T07:55:44","date_gmt":"2017-01-30T15:55:44","guid":{"rendered":"https:\/\/phcprimarycare.org\/?p=1841"},"modified":"2016-12-21T10:17:17","modified_gmt":"2016-12-21T18:17:17","slug":"shared-decision-making-what-it-is-and-why-it-matters","status":"publish","type":"post","link":"https:\/\/phcprimarycare.org\/?p=1841","title":{"rendered":"SHARED DECISION MAKING – WHAT IT IS AND WHY IT MATTERS"},"content":{"rendered":"

\u201cNothing about me without me\u201d<\/strong><\/em>\u2026. Picker Institute<\/p>\n

Every day as a busy clinician you make countless decisions regarding patient care. This includes decisions about diagnostic options, treatments, dispositions of patients, follow up and management of your patients.\u00a0 Some decisions have clear and compelling evidence, and few alternative paths. For example, a fractured hip needs to be repaired or acute bacterial meningitis needs antibiotics.\u00a0 Therapeutic action supersedes rigorous patient discussion (but does not completely replace it). However, for many medical decisions, the evidence is not compelling or there are multiple similar options. In this case, truly patient centered care asks for thorough discussion and consideration of patient\u2019s preferences and values in making the decision. For instance, which option to choose for early stage breast cancer has quite different effect on the patient\u2019s appearance, survival potential, and cost? This is what is called by the Dartmouth Atlas, \u201cpreference sensitive care\u201d. In these cases, engagement with the patient in making the decision in order to fully understand and take into account their preferences and values is of paramount importance. A Cochrane Review of shared decision making found that in 86 trials that were examined, there was a consistent improvement in patient knowledge, more accurate risk perceptions, greater number of decisions that were consistent with the patient\u2019s values, reduced level of internal decisional conflict, and fewer patients remaining undecided or passive.<\/p>\n

The Agency for Healthcare Research and Quality (AHRQ) has developed an approach to assist physicians and other caregivers in taking a systematic approach to Shared Decision Making. This approach called SHARE <\/strong>1<\/sup> provides a five step process that includes:<\/p>\n

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Step 1:<\/em><\/strong> S<\/u><\/strong>eek your patient\u2019s participation. Communicate that a choice exists and invite your patient to be involved in decisions<\/p>\n

Step 2:<\/em><\/strong> H<\/u><\/strong>elp your patient explore and compare treatment options. Discuss the benefits and harms of each option<\/p>\n

Step 3:<\/em><\/strong> A<\/u><\/strong>ssess your patient\u2019s values and preferences. Ask open and non-judgmental questions.<\/p>\n

Step 4:<\/em><\/strong> R<\/u><\/strong>each a decision with your patient. Decide on best option and arrange follow up<\/p>\n

Step 5:<\/em><\/strong> E<\/u><\/strong>valuate your patient\u2019s decision. Revisit the decision and monitor its implementation.<\/p>\n

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AHRQ provides shared decision making tools for both clinicians and for patients.\u00a0 These include:<\/p>\n