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Analysis

Embrace This Technique to Reduce Lawsuits and Complaints

By Christopher Cheney  
   January 18, 2019

Shared decision-making about health conditions is linked to lower likelihood of patient legal action.

Shared decision-making can significantly lower the probability that patients will file lawsuits and complaints, recent research indicates.

Multiple benefits have been associated with shared decision-making such as facilitating patient-centered care and managing overutilization of lab tests as informed patients forego invasive exams.  

Shared decision-making provides clinicians with a measure of legal relief, the research team wrote in the Annals of Emergency Medicine. "Although intent as reported on a survey does not always predict behavior, our results suggest that the use of shared decision-making confers medicolegal protection in the event of an adverse outcome."

The researchers used a Web-based research recruitment platform to enlist 800 study participants. The participants were surveyed after completing decision-making vignettes for an appendicitis scenario.

Study participants who engaged in brief or thorough shared decision-making were 80% less likely to want a lawyer than participants who did not engage in shared decision-making.

"Participants exposed to either level of shared decision-making reported higher trust, rated their physicians more highly, and were less likely to fault their physicians for the adverse outcome compared with those exposed to the no shared decision-making vignette," the researchers wrote.

There are three primary barriers to shared decision-making, the lead author of the research, Elizabeth Schoenfeld, MD, MS, assistant professor, Department of Emergency Medicine at UMass Medical School-Baystate, and adjunct faculty at Tufts University School of Medicine, told HealthLeaders recently.

1. Finding the time
 

"Clinicians feel that shared decision-making takes up too much time," Schoenfeld said.

It takes organizational commitment to include patient preferences in decision-making, she said.

"We can't just create work-arounds, like sending patients decision aids in the mail, or having a non-clinician start the shared decision-making process. We have to actually commit to giving clinicians time to have these conversations. Clinicians, for their part, can get better at having these conversations efficiently, but a conversation will always take longer than a directive," Schoenfeld said.

2. Weighing options
 

Clinicians often feel shared decision-making is inappropriate because the options are not equally advisable, she said.

"The clinician thinks that option A is probably better for the patient than option B, and therefore doesn't want to discuss the options. The problem with this is that many of our 'medically reasonable' decisions have consequences to patients that we have either not considered or have not given sufficient weight."

Clinicians need to commit to shared decision-making even when they think one option makes more sense, Schoenfeld said. "We need to remember that decisions that seem straightforward to us may be less so when the patient's preferences are considered."

3. Encouraging patient participation
 

Many clinicians assume that some of their patients do not want to be involved in shared decision-making, but patients want to be involved in decisions when they understand the consequences, she said.

"This means that clinicians should err on the side of thoroughly explaining options and consequences before they seek patient feedback. It also probably reflects that we could all be better at communicating medical decision-making."

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

Participants in a recent study showed an 80% lower propensity to pursue legal action if they engaged in shared decision-making than if they did not.

Benefits of shared decision-making include facilitating patient-centered care.

Commitment to shared decision-making is needed not only at the clinician level but also organizationally at health systems, hospitals, and physician practices.


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