You make important life decisions using the best information available. When you search for a job, you ask, “Is this a good fit for me?” You shop around for the house that best suits your needs. You read reviews and consumer research when buying a car.
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So when you make the most important decisions of all — about your health — you should have input and information, too.
That’s part of the idea behind shared decision-making, a trend in healthcare designed to improve care and patient satisfaction. Doctors work to learn as much as possible about your health conditions. But when it comes to how you feel and what you prefer, you know best. Put the two together, and you get shared decision-making.
To find out more about this approach, I interviewed Michael Rothberg, MD, Chair of Cleveland Clinic’s Medicine Institute Center for Value-Based Care Research.
How would you define shared decision-making?
Dr. Rothberg: Shared decision-making is a process in which patients and physicians make a decision together, incorporating the patient’s unique values, beliefs and medical condition.
In my experience, patients do prefer to be part of the process — once they realize they can be and that they have important information to contribute.
Does shared decision-making improve health outcomes?
Dr. Rothberg: The definition of an improved health outcome is different for different patients. This is a prime example of personalized healthcare and the impact of patient preferences. For example, if a patient is taking statins to prevent cardiovascular disease, they may have a lower risk of heart attack, but a higher risk for developing muscle pains or diabetes. Through shared decision-making, we will produce different outcomes. If it works correctly, patients will be more likely to get the outcomes they prefer, which will make them more satisfied. It is also likely to save money, because not everyone will choose the most expensive alternative.
In what circumstances would you encourage shared decision-making?
Dr. Rothberg: Shared decision-making is appropriate for most medical decisions. It is particularly useful when there is no obvious right answer.
For example, imagine a patient has heart disease and experiences chest pain when she walks up two flights of stairs. She has a stress test that shows a blockage in one of her coronary arteries. Studies have shown that placing a stent in that artery will improve her symptoms for a time but will not reduce her risk of having a heart attack. The decision to have the procedure should hinge on how bothered she is by the symptoms — and how much risk she is willing to undergo. No physician can answer that question for her, so shared decision-making is important.
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When would you advise against shared decision-making?
Dr. Rothberg: There is not much role for shared decision-making in emergency situations or when the decision requires a lot of technical expertise. However, once you start examining medical decisions, you realize that most of them could be shared. Something that seems technical — whether we should use a drug-eluting stent or a bare metal one — actually has implications a patient can understand. The drug-eluting stent is more expensive and requires that the patient take an antiplatelet medication for an extended period of time. The bare metal stent is more likely to get blocked and require another procedure.
In your experience, do patients prefer this approach? How about physicians?
Dr. Rothberg: In my experience, patients do prefer to be part of the process — once they realize they can be and that they have important information to contribute. Although some patients want to rely on the physician to make the ultimate decision, they do want their opinion and preferences heard. In the end, the greatest satisfaction comes from giving patients the healthcare that they want.