What Is Shared Decision Making?

Think back to the last time a health care provider recommended a treatment plan for you. How did you feel when you left their office?

1. My provider engaged me in conversation and considered my feelings and needs when it came time for us to choose a care plan. They heard my questions and concerns, and they made sure I understood the implications of all my health care options.
   
   
2. My provider gave me a diagnosis and one clear path for treatment, but we didn’t discuss any other options. They told me to make a follow-up appointment to begin next steps, but I didn’t completely understand why. I don’t know exactly what to expect.

If your appointment felt more like A than B, you’ve experienced the value of shared decision making.

Shared decision making is a way for health care providers and patients to collaborate on treatment decisions. It can build strong relationships between providers and their patients, but that’s not its only benefit. From helping patients stay more committed to their treatment choice to contributing to better health outcomes, there are several reasons you and your provider should be making decisions as a team.

In this article, we’ll explore shared decision making in health care, along with its advantages and disadvantages. Learn about its importance in providing a holistic care experience. 

What is shared decision making? As Karen Sepucha, PhD explains, it’s a method of collaboration between patients and doctors. Dr. Sepucha is director of the Health Decision Sciences Center at Massachusetts General Hospital.

“The ultimate goal of shared decision making is working together so that we can make sure we’re getting the best treatment to the patient,” says Dr. Sepucha. “It’s the idea that the provider is going to understand the evidence and figure out what the science tells us about what the options are, but we also recognize that the patients are the ones living with this disease.” 

Shared decision making can involve the use of decision aids—tools such as patient decision aids, shared decision-making skills trainings, measurement and feedback guidelines, and sometimes even decision coaches—which can be used in preparation for, or during, sessions. Decision aids are educational tools that support both patients and providers and are available for many health care decisions, from medicine to surgery and everything between. 

“Around 40 percent of malpractice claims are related to communication problems,” says Dr. Sepucha. This means that as a patient, feeling truly informed is key to achieving the best possible health outcomes. Through shared decision making, providers and patients can thoroughly discuss all possible side effects, outcomes, and treatment options.

Shared decision making and decision aids can also help reduce the gap in treatment for patients who struggle to navigate health care systems. Think: If you’re experiencing pelvic floor issues, should you see a urologist or an OB/GYN? If you sprain your knee, should you reach out to Orthopedic Surgery or Sports Medicine? With the right decision aids, you can have the answers you need to get the right care right away. 

In medicine, shared decision making means looking beyond a patient’s medical chart to truly understand their experience.

“A provider might have an x-ray, but that doesn’t tell them how bothered a patient is by their hip pain,” says Dr. Sepucha. “A doctor might have access to a pathology report, but that doesn’t tell them how worried they are about their condition.” 

When providers collaborate with their patients in a medical setting, they can get a better sense of the whole patient and find treatment options that might be more effective for them based on their goals, concerns, and needs.

Antonia F. Chen, MD, MBA actively engages in shared decision making with her patients and uses decision aids to help them understand what they need to choose an effective treatment. Dr. Chen is an orthopaedic surgeon at Mass General Brigham and director of Research, Arthroplasty Services at Brigham and Women’s Hospital.

“By using a shared decision aid, patients can understand the different options for surgery, what will happen if they do undergo surgery, and the pluses and minuses of surgical treatment,” Dr. Chen explains.

And, Dr. Chen says, shared decision making has empowered her patients, by opening their minds and arming them with the information they need to make the best decision. She has seen firsthand the ways in which decision aids can deepen and change patients’ health decisions for the better.

“I think the biggest change is when people think that you get a hip replacement or knee replacement and are instantaneously better,” she says. “They may come and say, ‘I definitely want surgery.’  And then you share [decision aids] with them and say, ‘Look: I think surgery can make sense for you. There are also non-operative options.’ So the change might be understanding that this is actually not a one-size-fits-all cure.” 

There are several advantages to shared decision making. These include:

• Enhancing patients’ commitment to treatment
• Helping providers communicate evidence for health care decisions
• Creating meaningful connection between patients and their providers
• Perfecting informed consent. After having a deep conversation, patients are well informed and can consent more honestly than simply signing a piece of paper.
• Setting realistic expectations for treatment and recovery

But, as Drs. Sepucha and Chen explain, there are a few potential disadvantages to the method as well:

• Taking up time. In some care settings, patients may not feel they have enough time to ask questions during their visits—but in fact, providers often value patient engagement. Mass General Brigham providers work to protect time to ensure patients feel heard and engaged.   
• Burdening patients with decisions. For patients who are struggling with symptoms or in pain, making a decision may feel difficult. They may prefer an expert’s guidance to know what they need to do to feel better.
• Addressing barriers in communication. Patients who speak different languages from their providers may worry about expressing their needs and being understood. Mass General Brigham hospitals can provide interpreters at request to help patients understand and be heard. Patients also may invite multilingual support people (family or friends) they trust to bridge communications.

In short, shared clinical decision making is an opportunity for you and your provider to work as teammates with the unified goal of finding the right treatment for you. With the right goal in sight and a collaborative approach to care, you can feel confident in each step in your health care journey.

“Mass General Brigham is at the forefront of shared decision making,” says Dr. Chen. “We have a huge repository of shared decision-making aids distributed at multiple sites. It’s pretty phenomenal to see what Mass General Brigham has done. We continue to lead the charge, and other institutions look to us for guidance on shared decision making aids.”