The Power of Shared Decision-Making

Patients who actively collaborate with their providers are more compliant and have better outcomes.

Patient education and shared decision-making are critical elements along a person’s journey to health and wellness. A successful provider-patient collaboration acknowledges a patient’s values and preferences when making care decisions and provides personalized healthcare information that is easy to understand and is actionable, says Julibeth Lauren, PhD. APRN, ACNS-BC, vice president and editor-in-chief, Elsevier Patient Engagement. “When patients are actively engaged in the development of their treatment plan, there is evidence to support improvement in patient outcomes, resulting in lower healthcare costs and readmissions,” she says. Lauren and her colleague Kate Ward, MPH, CHES, clinical content specialist, Elsevier Patient Engagement, explore the big shifts providers are making to improve patient care and education.

Q: Why is it important to tailor information to specific needs at each step of the patient journey?

Lauren: Our conceptual framework of the patient’s journey is more of a cyclical vs. linear model. For example, a patient can be very inquisitive at the discovery phase of their journey and start researching symptoms or a diagnosis. The discovery stage, however, can be overwhelming for patients if you give them all of the information they’ll need during their care journey at this stage. For example, they may not be ready to learn about self-management when they don’t fully understand the diagnosis or impact to their body yet. Knowing this, we create and deliver our education to patients in small digestible “chunks” of information, relevant to the phase of their patient journey and when they are most ready to learn about their health or medical condition. Providing key pieces of relevant information helps increase patient understanding and engagement.

Patients are more likely to take action and comply with the treatment plan when they are empowered through the shared decision-making process to collaborate with their provider and healthcare team on their plan of care. This is the direction Elsevier takes in creating content to deliver to patients at any point in their care journey.

Q: What can healthcare organizations do to help patients navigate through all the information and options presented to them?

Lauren: Organizations are already making great strides by doing literacy screening and identifying a patient’s preferred language for communication and method of learning. Taking appropriate action based on literacy screening is necessary to fully engage patients in their learning. This includes creating a culture in healthcare, which moves beyond a more prescriptive provider-patient relationship to one that is a shared decision-making relationship.

Shared decision-making takes into account the person’s needs throughout their entire care journey, from diagnosis to self-care and chronic disease management. Organizations should work with their healthcare teams to assess where patients are on their journey and provide them with tools to deliver the right information at the right time, and in the right way. For example, if a patient has had heart failure for the last two years, they may not need a sixth copy of ‘overview to heart failure.’ Instead, they may be having a challenge with medication management and that should be the focus of their education at this stage in their journey.

Q: Please define shared decision-making.

Lauren: The Agency for Healthcare Research and Quality (AHRQ) tells us that shared decision-making is the meeting of two experts, the patient and the provider, who work together to determine a care or treatment plan that outlines the risks and benefits, while balancing patient values, preferences, and medical best practices.

Q: How does shared decision-making influence collaboration between patients and healthcare professionals? How does it engage patients in their own care?

Ward: We live in a world where we often can compare multiple options with the click of a button. When shopping for a new car, before even setting foot into the dealership, a consumer can compare different makes and models side-by-side. Shared decision-making can help facilitate a similar experience for patients. Providers can start the conversation with their patients using an outline of several available care and treatment options within the context of the patient’s own values and preferences and their healthcare provider’s perspective. Discussing the evidence-based treatments, risks, and benefits improves understanding and helps patients feel prepared to make an informed decision.

Q: Describe how Elsevier incorporates shared decision-making principles into content.

Lauren: Elsevier Patient Education embeds patient-friendly, learner-centered, and shared decision-making principles in our multi-media content. We offer standardized and evidence-based information about treatment and procedure options. We also provide non-biased risks and benefits content, as well as information on potential impacts to lifestyle and quality of life issues. Our videos demonstrate shared decision-making by depicting discussions between patients and providers, with patients who are fully dressed (rather than in gowns) and sitting at a table (rather than lying in a bed or on an exam table). We recommend questions for patients to ask their healthcare provider. We include risks, benefits, and lifestyle impact. Lastly, we are excited to be able to offer Shared Decision-Making aids and tools to help facilitate provider and patient discussions and decisions in the very near future.

Q: How do organizations benefit from incorporating patient values and preferences in care decisions?

Lauren: We all share the same goal of helping patients achieve the best possible healthcare outcomes which align with their values and preferences. Increasingly, healthcare organizations have financial incentives to ensure that patients comply with their treatment plans post-discharge, and patients are more compliant with treatment plans when providers engage them early on in the decision-making process and listen deeply to their personal values and preferences.