Terri Coutee and Minas Chrysopoulo, MD FACS
Shared decision-making occurs when your doctor (or any healthcare professional) collaborates with you to make the best healthcare decision. The optimal decision takes into account evidence-based information about the available treatment options, the clinicians’ knowledge and experience, and any factors you value in your decision-making. The patient brings their preferences, goals, lifestyle, support structure, …whatever they feel is important to them in making a decision. The physician brings evidence-based information and their expertise. Together, they find the “sweet spot” in the middle. Our aim is to offer recommendations for patient and healthcare professionals to prepare for and have a shared decision-making conversation.
Most patients prefer this collaborative approach over deferring treatment decisions completely to their doctor. Unfortunately, in many cases patients may be reticent to initiate this type of conversation or simply don’t appreciate that they can. In reality, if the clinician doesn’t subscribe to shared decision-making, it simply won’t happen unless the patient advocates for themselves.
Multiple studies across several medial and surgical specialties show shared decision-making offers many benefits to both the patient and physician:
- Improves patient education
- Decreases patient anxiety
- Decreases decisional conflict
- Helps set appropriate patient expectations for the patient
- Improves patient satisfaction
- Improves patient outcomes
There are several challenges that patients and physicians must overcome to ensure a successful shared decision-making consultation. Challenges for patients and physicians engaged in this practice can include the personal interaction between the patient and physician, time constraints, understanding current information about your diagnosis, and the emotional stress patients often feel leading up to and during a consult.
Patient Recommendations to Prepare for your Shared Decision-Making Conversation
My experience as a two-time breast cancer survivor and entering a new consult has been fraught with nerves, sweaty palms, clammy arm pits, and the anxiety of not knowing what the final decision would be at the end of the consult. Those are some of the physical and emotional reactions many of us feel who are dealing with a new diagnosis of any kind. Time constraints for physicians due to their medical load can add challenges to this type of collaborative care. If we are going to be full partners in this shared decision-making process, understanding shortcomings and working toward solutions is incumbent upon both parties to ensure a successful experience and avoid decision regret on the part of the patient.
Despite these physical and emotional feelings combined with known constraints, I felt more empowered and prepared at my consults using the following methods:
- Researching terms in my lab reports helped me understand words and phrases that would likely be used at consult. I utilized trusted medical resources like PubMed, NCBI (National Center for Biotechnology Institute), BreastCancer.org, and other leading facilities like MD Anderson Cancer Center and Mayo Clinic to name a few.
- Use organization tools to take to your appointment to keep you on task, highlighting the pertinent information you researched and are seeking answers for.
- Be on time. Despite the fact your physician may be backed up due to circumstances beyond their control, it is imperative you are prompt. Look over your list of questions and topics to discuss if you have to wait.
- Dress as if you are going to an interview because you are. Wear comfortable, professional clothes that state, you are here to engage in a collaborative decision for your best outcomes. It does not have to be fancy. Make your wardrobe easy to remove for the exam but reflect who you are, a team member.
- Practice and visualize in your mind how you would like the consult to flow. Be prepared to give visual cues to the surgeon and his clinical staff in attendance when you do not understand something or need to have a procedure or treatment explanation repeated. Use clues like lowering your eyes or taking a pause in the conversation to help.
- Bring a trusted companion who will be there to sit, listen, and takes notes for you. Review them after the appointment to see if you missed something.
Physician Recommendations to Prepare for your Shared Decision-Making Conversation
- Get your team’s full buy-in ahead of time. All members of your team should understand what SDM is, and the many benefits it provides your patients and practice.
- Use decision aids ( e.g., Breast Advocate App), informative videos, and other technology to provide your patients with relevant information before and after the consultation. This will help your patients both prepare ahead of time and review afterwards at their own pace, and as often as they need to.
- Use the SHARE approach to guide your shared decision-making discussion:
- Ensure your patients not only understand the “what,” (i.e., their treatment options) but the “why,” the reasoning behind the recommendations as it relates to their situation and preferences. This will further enhance the patients’ buy-in into the treatment plan and your partnership.
- Create a patient advocacy group within your practice consisting of prior patients. As advocates, these former patients should be willing to discuss their experiences with new patients following similar treatment journeys. This not only serves as an additional form of support for new patients, but shared experiences can also provide significant reassurance and decrease decisional conflict.
- Let your patients know you fully embrace their right to seek a second opinion if they would like one. Encourage it if you feel your patient’s decision-making may be helped by it. This also develops a sense of trust with patients.
- Watch your patients for anxious moments and be ready to take a breath yourself, count to five, and let a moment of silence help the patient process what you have just told them.
Each Situation is Unique so be Prepared to Adapt
These are guidelines. Health care needs are great and varied in the world of cancer care and health care in general. Please use these recommendations to facilitate your shared decision-making conversation but also be prepared to tailor them and adapt based on the situation and your needs.