Shared decision making—long a conceptual cornerstone of patient-centered care—is increasingly being recognized and adopted as a tool for boosting the patient experience, enhancing patient engagement, and improving clinical outcomes. In this 3-part series, Avalere will examine shared decision making from multiple perspectives. In the series’ first installment, Sarah Alwardt, PhD, Senior Vice President and leader of Avalere’s Center for Healthcare Transformation, provides an overview of the benefits of and applications for shared decision making.

What is shared decision making? It’s a systematic process through which the patient and clinician work together to identify the best care plan and course of action based on the patient’s objectives, values, and concerns.

Isn’t that the way medicine already works? Not always. Many clinicians assume they engage in shared decision making but fail to realize that they are often making decisions primarily based on their own clinical preferences, training, and experience. Shared decision making gives patients both the agency and knowledge required to decide—in partnership with their clinician—which treatment option makes the most sense for them.

Why is that important? As testing and treatment pathways for many diseases expand, so do the cost-benefit tradeoffs for patients. This approach gives clinicians a new way to help patients make thoughtful, informed decisions when multiple pathways exist, and no 1 option presents is the obvious choice.

What are the benefits of shared decision making? Meaningful clinician-patient communication around treatment decisions have demonstrated a range of positive results. These include improved outcomes, greater patient engagement, better compliance with treatments, reduced anxiety, quicker recovery, and lower demand for healthcare resources.

Who is responsible for developing and implementing shared decision-making tools? Front-line clinicians introduce the concept to patients and provide access to shared decision-making aids and tools. But many physicians freely admit they lack information or insight into patient priorities and preferences. That’s why Avalere uses a patient-centric focus to develop effective shared decision-making tools, which requires input from a range of stakeholders.

How does Avalere develop shared decision-making tools? When creating decision-support tools for specific disease states, Avalere employs a human-centered approach that incorporates extensive feedback from patients, clinicians, physician specialty groups, and patient advocacy, research, and support groups. This process helps guarantee that the result (1) accurately reflects real-world patient concerns and priorities, (2) provides sufficient and clear information to support patient education and (3) facilitates treatment decisions in a product agnostic manner.

How do you get physician buy-in once the process is complete? After shared decision-making protocols and aids are developed, specialty societies can disseminate the information to their respective physician communities. Manufacturers and patient advocacy groups likewise can support this process by sharing information through a variety of channels.

How is shared decision making implemented? Shared decision making requires that clinicians adopt a systematic approach to fully engage with patients around specific care topics. The National Learning Consortium suggests a 6-step process:

1. Invite patients to participate: Let them know that they have options and that their goals and concerns are a key part of the decision-making process.
2. Present options: Ensure that patients are aware of all available options.
3. Provide information on benefits and risks: Offer balanced information based on the best available scientific evidence. Check back with patients to be sure they understand.
4. Assist patients in evaluating options based on their goals and concerns:To understand patients’ preferences, ask them what is most important to them and what their concerns are.
5. Facilitate deliberation and decision making: Let patients know that they have time to think things over and ask them what else they need to know or do before they feel comfortable making a decision.
6. Assist patients in following through on the decision: Lay out the next steps, check for understanding, and discuss any possible challenges in carrying out the decision.

What is the patient’s role? Patients should be prepared to articulate to clinicians their goals, fears, questions, and priorities. Since this can be difficult following a serious diagnosis, patients may need some time before they are able to make informed decisions. Decision aids focused on specific disease states and treatments can help during this period by providing a resource to help individuals reflect on their priorities and enhance their medical literacy. Decision-support aids are available in many forms, including web copy, infographics, printed material, prerecorded videos, and live webinars.

Why is shared decision making gaining traction now? The proliferation of health information on the internet, consumers’ increasing willingness to challenge medicine’s status quo, and ever-expanding treatment choices are accelerating both the need for, and acceptance of a more collaborative relationship that better accommodates the patient’s wishes, preferences, and goals.

What are some of the barriers to shared decision making?

One of the challenges facing clinicians is ensuring that decision aids are up to date and have kept pace with changing treatment protocols. In some therapeutic areas, decision aids may not yet exist. It is also important that clinicians develop strategies for communicating with all patients, regardless of an individual’s socioeconomic status or level of medical literacy. Patients, for their part, must overcome the tendency to assume that “doctors know best” and be willing to advocate for themselves.

What does the future of shared decision making look like? As healthcare continues to transition to a more patient-centered approach that can better address patient preferences and social determinants of health, shared decision making will likely play an expanding role at each step in the care process. In addition to helping patients navigate a range of available treatments for a given condition, shared decision making could be used to help operationalize vaccine recommendations and expand the breadth and diversity of clinical trials.   

Incorporating patient preferences may also be valuable for pharmaceutical manufacturers as the costs and diversity of treatment pathways increase. However, creating this kind of ecosystem requires consensus among all stakeholders regarding the intrinsic value of shared decision making, as well as a commitment to developing financial and quality metrics that both demonstrate and enforce its importance.

Next time: We explore how shared decision making can impact patient engagement and outcomes in oncology.