The New Norm of Patient-Centered Communication: Shared Decision Making
This post was written by Kristen Willard, M.S.
While patient-centered care may seem like an intuitive approach to healthcare, it has only dominated mainstream discussions of provider-patient relationships in the last several years. Practitioners have adopted this approach – or are working toward that end – given external pressures as well as an increasingly large body of literature demonstrating the effectiveness of patient-centered care in health care delivery and in impacting patient outcomes.
In their 2001 paper, “Crossing the Quality Chasm: A New Health System for the 21st Century,” the Institute of Medicine recommended dramatic changes to the then-current health care system, including an improvement agenda intended to achieve efficient processes and optimal health outcomes. Along with the essential elements of safety, effectiveness, timeliness, efficiency and equity, the organization includes patient-centeredness as a cornerstone of ideal patient care, defining it as “care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.”
In their 2012 Perspective piece for the New England Journal of Medicine, Dr. Michael J. Barry and Susan Edgman-Levitan took this several steps further, pronouncing a process called shared decision making as the “pinnacle of patient-centered care.” Shared decision making is loosely defined as the cooperative process engaged in by providers, patients and sometimes family members when determining a patient’s course of care. This approach stands in stark contrast to the paternalism that characterized physician-directed care through the early 21st century.
The Agency for Healthcare Research & Quality (AHRQ) has outlined five steps to successful shared decision making and has published a variety of resources for the healthcare community via their website.
Step 1: Seek your patient's participation – in a culturally sensitive and clear manner, explain to your patient his current clinical situation and delineate the options available to him. Invite him to be the center of his care team and participate actively in his healthcare.
Step 2: Help your patient explore and compare treatment options – elucidate any benefits and drawbacks to each of his choices and present these in a way to which the patient is most amenable (e.g., writing them down, using pictorial representations). AHRQ recommends employing the teach-back technique here, as well.
Step 3: Assess your patient's values and preferences – gauge what they want from the interaction and their treatment. This is a significant difference from the common approach of years past; what matters most is what is important to the patient and what aligns with their goals and values, rather than what the healthcare system believes the patient should want.
Step 4: Reach a decision with your patient – engage them throughout the decision- making process, which may be immediate or lengthier. Healthcare providers fulfill an important support role here, ensuring patients and family members are equipped with the information necessary to make an informed decision, while also allowing them the adequate time to arrive at that point.
Step 5: Evaluate your patient's decision – review the decision with the person and follow up to gauge how they are doing on all levels (e.g., emotionally, physically). Engage them to troubleshoot obstacles standing in the way of optimal outcomes.
Physicians, nurse practitioners, physician assistants, nurses, and case managers may be interested in exploring the following (non-CME) case study activity, “Engaging COPD Patients in Shared Decision-Making Across the Continuum of Care.”
One research article looking at shared decision making during hospitalization for acute exacerbations of COPD -- and another paper looking at lay health coaching (with roots in shared decision making) and its impact on correct inhaler use.
A physician’s experience in shared decision making with a patient with cancer.
A family member (who also happens to be a physician) shares her experience with a doctor’s paternalistic approach.
Is shared decision making an approach you practice?
This page was reviewed on March 5, 2020 by the COPD Foundation Content Review and Evaluation Committee