Improving Value

Shared Decision Making

The U.S. healthcare system is notorious for being complex and difficult for patients to navigate on their own. Although there have been many efforts to increase patient activation, such as consumer-directed health plans and changes in delivery, today's health system is far from reflecting consumers' true needs and preferences.1 

Patient shared decision-making (PSDM) incorporates patients' needs and preferences into their individual treatment plans. PSDM goes beyond traditional informed consent in healthcare - it is an interpersonal, interdependent process in which healthcare providers and patients collaborate to make decisions about the care that patients receive. Shared decision-making not only reflects medical evidence and providers' clinical expertise, but also the unique preferences and values of patients and their families.

The evidence around shared decision-making is fairly strong. Shared decision-making improved patient-doctor communications, improved outcomes and increase patient and physician satisfaction. Despite very promising evidence, shared decision making has not been widely implemented in clinical practice.  In a study of more than 1,000 office visits in which more than 3,500 medical decisions were made, less than 10 percent of decisions met the minimum standards for shared decision making.2 Shared decision-making is a key component of person-centered healthcare and should be the standard of care. Training and physician reimbursement should reflect this priority.  

 

Notes

1. Ditre, Joe, "Consumer-Centric Healthcare: Rhetoric vs. Reality," Healthcare Value Hub, Research Brief No. 18 (May 2017). 

2. Braddock, Clarence H., et al., “Informed Decision Making in Outpatient Practice,” JAMA Network (December 1999).

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