By Lydia Hansen, undergraduate public affairs intern
Shared decision making between patients and providers plays a crucial role in health care experiences and outcomes. However, each patient and each health care experience is unique, so no one approach to shared decision making is appropriate in all situations.
“There are many different ways that decisions can be shared between patients and providers, depending on the situation,” says Ian Hargraves, first author on the paper.
In recent years, says Dr. Hargraves, models of shared decision making discussed in the literature have focused on securing patient involvement in decision making with less attention on the purpose of that involvement—why each patient and their clinician are making a decision and in response to what problem. “The purpose should come first,” says Dr. Hargraves.
In the paper, the researchers call their problem-based approach “purposeful shared decision making.” The important thing about this approach, they say, is the decision making varies according to what the patient is experiencing in their illness, treatment, and life.
The paper’s authors identify four kinds of situations in which shared decision making is often needed. Each of these requires different methods of shared decision making.
|Purpose||Shared decision making method||Example|
|Choosing between alternatives||Weigh pros and cons||Choosing between two medications|
|Choosing between different desires||Intrapersonal or interpersonal negotiation||Choosing the method of childbirth right for you|
|Managing a difficult health care situation||Use conversation to problem solve. Test hypotheses to determine the nature of the situation and how best to resolve it.||Dealing with the intellectual, practical and emotional challenges of a family member's serious illness|
|Deciding what matters most when it comes to health||Use dialogue to bring people together and create shared meaning||Facing an important life transition, such as a death|
In the purposeful shared decision making model, how and to what extent patients and clinicians participate in decision making changes with the situation, the method of shared decision making that they’re using, as well as the people involved. Shared decision making goes beyond involving patients, it involves a delicate dance to find the right way to interact so that each can best contribute to resolving the patient’s situation.
Shared decision making is being required of clinicians more and more at all levels of health care, says Dr. Hargraves. Research into new models, like purposeful shared decision making, he asserts, will help shape the way that these approaches are integrated into everyday patient care.
“We need to develop interventions and ways to support and train clinicians in using and understanding the variety of shared decisions making methods and the situations where they apply,” Dr. Hargraves says.
In addition, he calls for further research on patient-physician communication to identify situations where the four approaches to shared decision making are already being used as part of everyday practice. A more comprehensive understanding, he says, will help researchers develop better models and better measures of quality and success.
Learn more about Mayo’s research on shared decision making in health care