Enhancing Patient Engagement through Shared Decision-Making

What Is Shared Decision-Making?

According to the ONC, shared decision-making (SDM) is “a process in which clinicians and patients work together to make decisions and select tests, treatments and care plans based on clinical evidence that balances risks and expected outcomes with patient preferences and values.”

Through thoughtful patient education and patient-provider communication, patients can move beyond passive participation in care and become a healthcare collaborator. Shared decision-making requires providers to combine their own clinical expertise with the knowledge that patients have about themselves, their priorities, and their values.

Shared decision-making can be broken down into a handful of seemingly simple steps: identify the patient’s condition, discuss treatment options, elicit patient preferences and values, and carry out the care decision.

Overall, it is the provider’s job to determine the extent to which the patient wants to participate in shared decision-making, then outline treatment options and the impacts of those options. From there, providers should ask patients about their own quality-of-life goals and lifestyle needs.

Ultimately, that should help build autonomy for patients and assist them in taking ownership of their own health and well-being.

Benefits of Shared Decision-Making

Practicing shared decision-making can have two primary benefits: improving patient satisfaction by way of better communication and improving patient adherence to clinical guidelines.

Shared decision-making can potentially improve patient satisfaction with communication because it honors patient preferences for greater autonomy and participation in their own care. One March 2020 report showed that patients who engaged in shared decision-making for their diabetes care reported higher patient satisfaction levels.

Patients who engage in shared decision-making may feel more listened to by their providers. Moreover, they are more likely to get the medical treatment that they actually want, which can also have a positive impact on patient satisfaction reports.

In addition to improving the quality of patient-provider communication, shared decision-making can actually have impacts on patient adherence to clinical guidelines. In 2021, researchers from the Cleveland Clinic found that a shared decision-making tool outlining possible preventive screenings a patient would need increased patient adherence to clinical guidelines.

Patients who accessed the tool were more equipped to identify the preventive services that would make the biggest impact on their life expectancy and overall health, with 69 percent identifying such compared to just 30 percent of patients who did not access the tool. Those viewing the decision aid were also better equipped to identify which services would not improve their life expectancy or quality of life.

Separate research has emphasized the key role the provider plays in facilitating shared decision-making, particularly in patient education. Shared decision-making is not possible when patients do not have access to all relevant information, and when providers cannot be the arbiters of that patient education, communication falls flat, according to a 2022 study in JAMA Network Open.

The researchers looked at whether patients who engaged in shared decision-making for lung cancer screening declined the service. The team observed that the physician or hospital the patient visited swayed whether they declined a screening after shared decision-making, which the researchers said could indicate that providers did not facilitate as robust of a conversation as providers at other organizations.  

Indeed, practicing shared decision-making can be challenging for providers, largely due to time constraints.

Challenges of Shared Decision-Making

It would be easy to find a consensus in favor of shared decision-making; it is difficult to argue with the concept of helping patients make an informed decision about their medical care.

But where providers run into trouble with shared decision-making is time. Clinicians are famously hard-pressed for time during clinical encounters, and the process of delivering the patient education necessary for shared decision-making could make that problem worse.

For some clinical decisions, like the decision to continue chemotherapy amid a nearly terminal prognosis, shared decision-making should be a lengthy conversation.

But shared decision-making is also important in lower-acuity settings like primary care, and a group of researchers said the approach to shared decision-making could be adjusted in that specialty. After all, primary care providers only really have around one or two minutes to spend on shared decision-making, they said.

In a 2020 paper published in the Journal of General Internal Medicine, the researchers introduced the concept of “everyday shared decision-making,” which abbreviates some of the lengthy conversations that happen when one imagines shared decision-making. The researchers said primary care providers could limit their informative discussions to around 30 seconds, move on to supporting patient autonomy, and answer questions upon patient request.

Moreover, integrating tools like decision aids into the mix could help limit the amount of time providers spend on patient education and allow them to focus more on answering questions and counseling patients.

Decision Aids, Tools for Shared Decision-Making

Decision aids are patient education tools that providers can leverage to help facilitate shared decision-making. These tools can be offered either digitally or on paper, and healthcare organizations should ensure they employ decision aids that are written with patient health literacy in mind and account for language preferences.

Moreover, organizations should consider developing or purchasing decision aids that include price transparency information, especially considering the patient financial responsibility that comes with many healthcare services. Understanding how much a service will cost is just as useful information as the impact it will have on patient quality of life, revealed a FAIR Health assessment of its own decision aids.

Notably, decision aids get at that time problem most clinicians cite when considering shared decision-making. According to the FAIR Health assessment, providers said that using decision aids makes it easier for them to incorporate shared decision-making into clinical practice.

Some assessments have also shown that shared decision-making tools can be helpful for driving patient engagement among minority patients, a key goal amid healthcare’s efforts toward equity. A separate FAIR Health assessment showed that 80 percent of patients of color found decision aids helpful, and three-quarters would recommend the tools to family or friends.

As more tools and strategies arise to facilitate shared decision-making—and as providers face growing demand from patients who want to be partners in their care—it is likely that this practice will take hold in clinical practice.

Healthcare providers working on boosting shared decision-making during patient encounters should consider their own role in patient education, the tools that can supplement that education, and the counseling they provide to patients as patients elucidate their own health goals.