Here (and in our previous post) we plan to answer all your questions about Shared Decision Making and how to do it with Maternity Neighborhood. According to a 2014 Institute of Medicine Roundtable on Value and Science-Driven Healthcare, shared decision making is an emerging standard for patient-centered care and is increasingly supported by federal and state legislation because of its clear potential to improve care delivery and reduce costs.
While some tools exist to support obtaining informed consent, Care Guide’s eConsents workflow allows a multi-step process of researching and communicating about options, exploring and clarifying preferences, and collaboratively developing a care plan.
What is Shared Decision Making (SDM)?
The Informed Medical Decisions Foundation (IMDF) defines SDM as “a collaborative process that allows patients and their providers to make health care decisions together, taking into account the best scientific evidence available, as well as the patient’s values and preferences.” This process could be a single conversation or a multi-step process of researching and communicating about options, exploring and clarifying preferences, and collaboratively developing a care plan.
SDM is a key component of national, regional, and local efforts to improve healthcare quality and adopt more patient-centered care models.
Is SDM the same as informed consent?
SDM has been referred to as “perfected informed consent.” The current way informed consent happens in typical healthcare settings does not reflect or accurately document the full process necessary to arrive at an informed decision to consent to or decline a test, procedure, or treatment. SDM allows a process that fully incorporates the patient/person’s preferences, values, and individual circumstances as well as the best available evidence and can result in a consent or a refusal decision.
Is there a best way to do SDM?
There are many different ways to incorporate SDM into practice, and SDM models will vary based on the type and urgency of the decision, the resources available in the healthcare setting, the patient population, and other factors.
SDM researchers and implementation specialists emphasize the need for health care providers to proactively engage in three phases of SDM with patients:
- Choice talk – ensuring that the individual is aware that she has a choice among two or more reasonable options, that her preferences matter, and that outcomes are uncertain so she will have to weigh risks and possible benefits.
- Options talk – ensuring the individual understands the full range of options and their associated advantages and disadvantages, including the option of doing nothing.
- Decision talk – anchoring on the individual’s preferences and arriving at a decision that is consistent with those preferences and informed by the best available evidence.
Although the researchers describe these phases as “talks,” they emphasize that some parts of the process need not be done face-to-face and may involve digital communications and use of print or online decision support tools, such as Decision Aids.
What is a Decision Aid and does SDM always involve using one?
SDM can occur with or without Decision Aids (DAs).
DAs are structured educational tools that present standardized information about options and their advantages and disadvantages and help people weigh the options in the context of their preferences, values, and individual circumstances. Decision Aids are helpful because they are generally developed by subject matter experts, incorporate the best available evidence, and are kept up to date. High-quality evidence suggests they improve knowledge and awareness of options, improve decision quality, and may reduce use of elective procedures.
However, DAs are available for only a small number of common health care decisions, and their quality varies. Efforts are underway to improve the quality of DAs, increase the availability and use of DAs for a range of healthcare decisions, and impose standards for certifying DAs. A list of available decision aids, including a general decision aid that can help with any kind of healthcare decision, can be found at https://decisionaid.ohri.ca/index.html
Have you tried using the Decision Aids from our partners at the Dartmouth Preference Lab that already part of the Maternity Neighborhood Care Guide? Check it out here: https://my.maternityneighborhood.com/library/d1236f13-2325-4993-85cb-c5a046c2cba9
Is SDM part of the Affordable Care Act or other healthcare legislation?
The Affordable Care Act (ACA) includes provisions to promote the use of Decision Aids for Shared Decision Making and includes many provisions that address the need for more patient-centered approaches to care. However, specific SDM provisions have not been funded so progress has been slow. Several states, most notably Washington, have enacted laws that promote or incentivize SDM and use of DAs. Before they are fully implemented, these efforts need additional policy attention to determine standards and documentation requirements. It is likely that both federal and state lawmakers will continue to favor SDM and work on legislation to incentivize or require its use.