Why and How to Incorporate Shared Decision-Making In Clinical Practice

Shared decision-making plays a key role in providing patient-centered care. According to the National Learning Consortium (NLC), shared decision-making is a process in which clinicians and patients collaborate to make decisions and create care plans based on both clinical evidence and patient preferences.

The Agency for Healthcare Research and Quality (AHRQ) emphasizes that this model of patient care relies on two major premises: First, patients who are equipped with quality information can and will participate in decisions about their health by asking questions and expressing their opinions. Second, physicians must respect these preferences and use them to guide their recommendations. 

Following, we examine the benefits of shared decision-making, plus tips and strategies to incorporate it into clinical practice.   

The Benefits of Shared Decision-Making

Shared decision-making has benefits for both patients and physicians. For patients, NLC states that when individuals are involved in decisions about their own healthcare, they’re more likely to understand what actions they need to take and to follow through with them. According to AHRQ, this also leads to better health outcomes. Physicians who utilize shared decision-making report that patients are more knowledgeable, better prepared for conversations and more understanding of care goals. Practitioners also state that shared decision-making helps build stronger patient relationships with higher degrees of satisfaction for both those providing and receiving care.  

Although shared decision-making has utility in many clinical interactions, NLC states it can be especially useful when there is no singular “correct” care decision. Sometimes there may be multiple treatment options, or there might be pros and cons for a particular plan. Discussing these factors with a patient can lead to optimal care that aligns with an individual’s values and priorities.

Strategies to Implement Shared Decision-Making

For this care model to be successful, correct implementation is key. NLC outlines six steps to incorporate shared decision-making into clinical practice:

1. Invite the patient to participate, letting them know they have options and that they play a key role in care decisions. To begin these conversations, NLC suggests using language that underscores the importance of working together to reach decisions while asking about priorities.
2. Explain the available options.
3. Share information on the advantages and disadvantages of each option, remembering that it’s best to provide evidence-based facts. After explaining the pros and cons, be sure to confirm that the patient understands the information.
4. Seek to understand the patient’s preferences and concerns. Then use their feedback to evaluate options.
5. Give the patient time to think through their choices and offer support by answering additional questions. Then provide space for decision-making.
6. Once a decision has been made, describe the plan to bring it to action. It may be helpful to discuss any anticipated challenges. 

Additional Tips for Success

In addition to the strategies listed above, the following tips from AHRQ may help in the shared decision-making process.

• Consider using patient decision aids. Although patients have access to a myriad of resources, including friends, family, the Internet and printed materials, patient decision aids, such as risk calculators, can offer another level of support. These tools—available in digital and print forms—present issues fairly and clearly while highlighting the benefits and risks of each option. They can also help users process and articulate their own opinions. AHRQ emphasizes that quality decision aids offer balanced, nonbiased information that do not encourage one treatment approach over another. Learn more about patient decision aids here.

• Take a team approach. Quality healthcare often involves more than just one clinician. Involving broader care teams, such as nurses, health coaches and more, can help draw a more comprehensive picture of the patient’s health journey.

• Help patients take responsibility in advancing knowledge. It’s critical that patients take the initiative to become more knowledgeable about their health and related options. It may be beneficial to encourage patients to reach out to support groups, coaches or other educational programs that can deepen their understanding of health issues.

• Continually evaluate the decision-making process within your organization. AHRQ recommends soliciting feedback from patients to learn more about their perspectives and health experiences by asking if they felt like they understood their options and whether they felt heard by their care teams. 

Ultimately, shared decision-making requires a shift away from traditional models of the patient-provider relationship. Citing an article by Deber, Kraetschmer and Irvine in Archives of Internal Medicine, AHRQ reminds physicians that shared decision-making necessitates a “modification of the relationship between patient and provider and recognition of the ability of the patients to participate in making choices that affect their lives.”