This concept of Shared Decision Making is a relatively new one for me and so, as usual, I want to start with a definition. This one is a good general definition from a handout from www.healthit.gov:
Shared decision making is a key component of patient- centered health care. It is a process in which clinicians and patients work together to make decisions and select tests, treatments and care plans based on clinical evidence that balances risks and expected outcomes with patient preferences and values.https://www.healthit.gov/sites/default/files/nlc_shared_decision_making_fact_sheet.pdf
If you are left a little mystified by how shared decision making is actually accomplished, then this article’s abstract helps a little more:
The principles of shared decision making are well documented but there is a lack of guidance about how to accomplish the approach in routine clinical practice. Our aim here is to translate existing conceptual descriptions into a three-step model that is practical, easy to remember, and can act as a guide to skill development. Achieving shared decision making depends on building a good relationship in the clinical encounter so that information is shared and patients are supported to deliberate and express their preferences and views during the decision making process. To accomplish these tasks, we propose a model of how to do shared decision making that is based on choice, option and decision talk. The model has three steps: a) introducing choice, b) describing options, often by integrating the use of patient decision support, and c) helping patients explore preferences and make decisions. This model rests on supporting a process of deliberation, and on understanding that decisions should be influenced by exploring and respecting “what matters most” to patients as individuals, and that this exploration in turn depends on them developing informed preferences.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445676/
Why has this concept been on my mind? Well, it all started with social media …
I’m still learning all the different social media platforms and each definitely has its pros and cons. On Twitter, I do find myself getting into more pointed discussions/disagreements and I see that happens with others too. And yet, I appreciate all of the people willing to enter into discussions, even if the exchanges get a little heated or intense at times.
Yes, I am typically intense.
Not sure anyone reading this is at all surprised by that statement if you’ve read my posts for any amount of time.
And so it was the other day on Twitter that I got into a discussion about this idea of “Shared Decision Making” as I was also helping several very newly diagnosed ladies adjusting to huge life changes as a result of Stage IV Metastatic Breast Cancer. One young woman is also treated by my medical oncologist and was struggling with some issues with communication and a new diagnosis in the midst of COVID restrictions. I’ve been coaching her on how to best communicate with our shared oncologist, since I have a few years of working with her under my belt.
The point of the thread on Twitter started with a question about the role of empathy in the context of breast surgery decision making and quickly morphed into this idea of shared decision making. It was a doctor who posited that oncologists should display empathy and also enter into shared decision making with the patients, suggesting that empathy was required in order to have shared decision making. I chimed in, because I often do, suggesting that empathy isn’t actually what I look for from an oncologist, that information and good communication of information is key. Needless to say, this wasn’t received that wall.
Bottom line, I take issue with this idea of shared decision making because language is important.
Yes, doctors have much more information and training than anyone who hasn’t been to medical school and hasn’t had experience in the practice of medicine; at the same time, unless someone has been deemed legally incompetent to make medical decisions, no doctor has the ability to make decisions on behalf of a patient. There is no shared decision making in actual fact because doctors either recommend or make decisions, there isn’t anything in between.
Let me say this again: Doctors and other medical professionals recommend and advise from their position of information and training and patients make decisions.
Let’s go back to my new friend who I was coaching/mentoring. Our shared medical oncologist gives information, helps with pros and cons, usually makes some recommendations, but sits back to allow the patient to make the decisions. This has worked really well for my doctor-patient relationship since I do my own research and look to her for information/guidance before making a decision as well as to ensure that I haven’t missed anything. My new friend was waiting for our shared oncologist to tell her what to do and was frustrated that our shared medical oncologist kept giving her options and asking her, the patient, for the decision.
I’m fully aware that this is a triggering issue for me since so much of my autonomy as a human being is attacked by the medical system and I’ve written quite a bit about that. Is this a real issue? Is this label an attack on patient decision making as it seems to me?