Using Shared Decision-Making to Enhance Informed Consent Conversations

When patients are tasked with making difficult medical choices, a patient decision aid (PDA), used as a part of the shared decision-making process, can be an effective strategy that boosts patient health literacy of the surgical procedure.

This improved understanding can consequently enhance informed consent conversation leading patients to make well-considered decisions, an American Journal of Roentgenology (AJR) study sent to journalists indicated.

“Well-vetted plain-language PDAs provided before image-guided procedure consent conversations improve patients’ self-perceived understanding of the procedure and satisfaction with the conversation,” corresponding author Eric J Keller, MD, MA, from the division of interventional radiology at Stanford University in California, said in a press release.

Informed consent conversations require strong, informative patient education, resulting in patient approval of the treatment. These conversations regarding medical treatment need successful communication to establish a positive patient-physician relationship built on trust, researchers stated.

However, information is often presented in a manner beyond the health literacy of patients, which is a barrier preventing successful patient-provider communication.

Additionally, inadequate periprocedural communication is a common source of patient dissatisfaction and medical errors.

To evaluate the impact of PDAs on informed consent conversations, researchers included patients awaiting an interventional radiology clinic visit to discuss informed consent for an image-guided procedure.

The study, conducted at different academic medical centers, randomly allocated patients to receive or not receive a PDA prior to the clinic. These PDAs described specific imaging procedures, as well as their benefits, risks, and alternatives.

To ensure they met ethical criteria, PDAs were written at the CDC’s recommended health literacy level of 6th to 8th grade in plain language

Additionally, the interventional radiologists discussing the procedures were unaware of whether or not patients had received a PDA.

A post-visit survey evaluated patient understanding and satisfaction with their consent conversation.

The study findings concluded that patients who received a PDA before their visit reported a greater understanding of the procedure and its benefits, risks, and alternatives, as well as greater satisfaction with the consent conversations.

Additionally, patients who received a PDA were more likely to perceive better clinician-provider communication. For example, patients in the intervention group reported that the clinician had listened to them, spent sufficient time with them, and answered all of their questions without changing anything about the visit itself.

Despite their validated benefit, limited adoption patterns are keeping PDAs from achieving full potential, the researchers said.

Limitations such as time constraints, limited reimbursement structure, and few tools to facilitate shared decision-making have kept providers from adopting the strategy in any meaningful way.

However, with more evidence backing shared decision-making, some healthcare experts are starting to recognize the importance of PDAs.