Clinical Care Access to Care Quality of Care Search Policies & Programs

hints
Display All Policies & Programs

Patient shared decision making

Health Factors: Quality of Care
Decision Makers: Healthcare Professionals & Advocates
Evidence Rating: Scientifically Supported
Population Reach: 50-99% of WI's population
Impact on Disparities: No impact on disparities likely

Is this program or policy in use in your community? Tell us about it.

Description

Under a shared decision making (SDM) process, health care practitioners and patients work together to make joint decisions about a patient’s care. SDM requires that patients be educated about and understand risks and benefits of their options (Cochrane-Legare 2010). SDM is an important part of patient-centered care; education is often through the use of decision aids such as pamphlets, videos, and computerized tools.

Expected Beneficial Outcomes

Improved patient knowledge
Improved patient decision making
Improved health outcomes
Reduced use of expensive procedures

Evidence of Effectiveness

There is strong evidence that patient shared decision making (SDM) using decision aids improves patients’ knowledge of treatment options and increases their involvement in the decision making process (Cochrane-Stacey 2014, OBrien 2009). Patient SDM using decision aids may also improve health outcomes (Cochrane-Legare 2010).

Decision aids increase patients’ knowledge about their treatment options (Cochrane-Stacey 2014, OBrien 2009) and can reduce anxiety related to treatment (Dugas 2012, Joosten 2008, OBrien 2009). Using probabilities in those aids, especially expressed in numbers, improves the accuracy of the level of risk patients perceive (Cochrane-Stacey 2014). Computerized aids appear as effective as aids delivered in person (Sheehan 2012).

Decision aids improve patient participation in their treatment decisions (Cochrane-Stacey 2014) and help patients make difficult decisions (Cochrane-Stacey 2014, OBrien 2009). SDM has been shown to be particularly effective for patients making long-term decisions and patients with chronic health problems (Joosten 2008). Use of decision aids has been shown to reduce the frequency of major elective surgeries, PSA screening, and the choice to use menopausal hormones (Cochrane-Stacey 2014). SDM can also support women’s decision making related to pregnancy and birth (Dugas 2012). Educational meetings, feedback, learning materials, and decision aids may help health care providers adopt SDM (Cochrane-Legare 2010).

The impact of patient shared decision making on health care costs is unclear. Some studies show no savings, though no additional costs, while others suggest per person savings ranging from $8 to $3,068 (Walsh 2014).

Implementation

United States

The Informed Medical Decisions Foundation supports 10 shared decision making demonstration sites across the country. It also has developed a variety of decision aid programs, focusing on topics such as breast cancer, cardiovascular disease, screening and testing programs, and mental health (IMDF).

Wisconsin

Individual health care systems may implement SDM, however, there is no SDM legislation in Wisconsin (IMDF).

Implementation Resources

IMDF-Resources - Informed Medical Decisions Foundation (IMDF). Shared decision making resources. Accessed on February 5, 2016

Citations - Description

Cochrane-Legare 2010* - Légaré F, Ratté S, Stacey D, et al. Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database of Systematic Reviews. 2010;(5):CD006732. Accessed on December 8, 2015

Citations - Evidence

Cochrane-Legare 2010* - Légaré F, Ratté S, Stacey D, et al. Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database of Systematic Reviews. 2010;(5):CD006732. Accessed on December 8, 2015
Cochrane-Stacey 2014* - Stacey D, Légaré F, Col NF, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews. 2014;(1):CD001431. Accessed on November 23, 2015
Dugas 2012* - Dugas M, Shorten A, Dubé E, et al. Decision aid tools to support women’s decision making in pregnancy and birth: A systematic review and meta-analysis. Social Science & Medicine. 2012;74(12):1968–78. Accessed on January 14, 2016
Joosten 2008* - Joosten EAG, DeFuentes-Merillas L, de Weert GH, et al. Systematic review of the effects of shared decision-making on patient satisfaction, treatment adherence and health status. Psychotherapy and Psychosomatics. 2008;77(4):219–26. Accessed on March 1, 2016
OBrien 2009* - O’Brien MA, Whelan TJ, Villasis-Keever M, et al. Are cancer-related decision aids effective? A systematic review and meta-analysis. Journal of Clinical Oncology. 2009;27(6):974–85. Accessed on May 18, 2016
Sheehan 2012* - Sheehan J, Sherman KA. Computerised decision aids: A systematic review of their effectiveness in facilitating high-quality decision-making in various health-related contexts. Patient Education and Counseling. 2012;88(1):69–86. Accessed on November 9, 2015
Walsh 2014* - Walsh T, Barr PJ, Thompson R, et al. Undetermined impact of patient decision support interventions on healthcare costs and savings: Systematic review. BMJ. 2014;348:g188. Accessed on January 27, 2016

Citations - Implementation

IMDF - Informed Medical Decisions Foundation (IMDF). Advancing shared decision making. Accessed on February 17, 2016

Page Last Updated

September 4, 2014

* Journal subscription may be required for access.