Empowering patients through shared decision making

Pioneering physician, author, and researcher Tom Ferguson (1943-2006) stated that “whenever the people are well-informed, they can be trusted with their own health. We don’t need doctors or health systems to rule our bodies.”

The core of patient-centered healthcare is to engage the patient in decisions about their own care and treatment.

Every patient is unique in their own views, values, preferences, and life circumstances. This has a strong bearing on the choices they make when it comes to choosing an appropriate treatment for their condition. So it is not just a question of clinical effectiveness, but of balancing the potential benefits and harms of different available options to find what is most appropriate for the individual.1

Shared decision making (SDM) has been defined as “an approach where clinicians and patients share the best available evidence when faced with the task of making decisions, and where patients are supported to consider options, to achieve informed preferences”.2 It can also be defined as a process in which patients are involved as active partners with the clinician in clarifying acceptable medical options and choosing a preferred course of care and treatment.3 This would also take into account the patient’s needs, desires and lifestyle.

Every human being has a tendency to protect and preserve their wellbeing. The core of SDM is to make patients aware of their responsibility towards their own wellbeing. Therefore, an individual’s self-determination is a desirable goal of SDM, and clinicians need to support patients to achieve this goal, wherever feasible.2

SDM is not just about sharing information, but also honoring the patient’s preferences, which are influenced by psychological, social and emotional factors.
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If we look at the following example:

Doctor prescribes “Drug A” to the patient, who is a model by profession, with the knowledge that the drug might lead to weight gain. Over a period of time, the extent of the weight gained turned out to be an unexpected consequence to the patient, affecting her state of mind. Looking back, the patient felt that if she had been given more information and a chance to discuss her preferences, then the situation might have been different.

Some healthcare professionals share the belief that the patient does not have the ability to make the right choices regarding his or her health and could easily make an incorrect decision. Helping the patient make the right decision, along with the transfer of information and understanding patients’ preferences, would be considered an effective partnership between the doctor and the patient. The success of such a partnership would depend upon the counselling and communicative ability of the caregiver. The clinical consultation needs to be structured in such a way as to share information about options for tests, treatment and management, as well as to support patients in thinking through these choices, in order to make an informed decision.4
Doctor-And-Patient discussion
A proposed model to structure the SDM process has 3 stages:4

  1. Choice talk: introducing the patient to the fact that there are choices they can make about their treatment and management.
  2. Option talk: describing the options available and discussing the evidence in terms of potential benefits, risks and consequences.
  3. Decision talk: helping patients explore their personal preferences and using these, together with the evidence, to make an informed decision.

Therefore, to state it simply, SDM is a process that includes the transferring of information, understanding patients’ preferences and helping the patient to make the right decision.

Shared decision making is a step towards patient centered care.

Dr. Shalini Ratan Dr. Shalini Ratan, MD, is Founder and Chief Knowledge Facilitator at Nirvan Life Sciences Pvt Ltd. Mumbai, India.

References (click to show/hide)

  1. Choosing treatment. Invest in Engagement. Available on http://www.investinengagement.info/
  2. Glyn Elwyn et al. Shared Decision Making: A Model for Clinical Practice. J Gen Intern Med 27(10):1361–7.
  3. Sheridan SL et al. Shared decision making about screening and chemoprevention. a suggested approach from the U.S. Preventive Services Task Force. Am J Prev Med. 2004 Jan; 26(1):56-66.
  4. Shared Decision making Resource Centre. Available on http://www.health.org.uk/


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