Shared Decision Making: Patient Perspectives

When it comes to working with doctors, it can seem hard to be “in the room” — even when you’re actually in the room.

Traditionally, the doctor-patient relationship looked something like this:

A person would show up in the clinic with a chief concern or a recurring health condition. After some explanation, the doctor would perform a physical exam and then decide the course of treatment and place orders for tests and medications.

However, the clinical experience is shifting — and patients are being increasingly included in the clinical decision-making process. As a result, patients have more autonomy and power to help determine care plans with their lupus treatment team.

How would you rate your lupus treatment team? Are there topics you wish they would cover more during visits?

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What is Shared Decision Making?

Shared decision making is a bit of a buzzword, but it gets at theories of care that have been in healthcare for a long time. Simply, shared decision making is an approach to healthcare where the doctor and patient work together to make health decisions.

“But, wait. I don’t know which treatment option is best for me… that’s why I’m at the doctor.” Shared decision making is about making you, as a patient, do tons of more work. It’s about increasing patient autonomy in a field where there often multiple treatment choices.

Patient autonomy and shared decision making

Increasingly, there is not one fixed treatment plan for lupus and other health conditions. Instead, there are a number of treatments that each have pros and cons.

When using a shared model for decision making, doctors encourage their patients to share personal beliefs, including risk thresholds, to determine appropriate options.

Other clinicians have built models that may help doctors and patients work together. One such model, published in 2012 in the Journal of General Internal Medicine defines a 3-step process for shared decision making:

1. Choice talk
   • During this phase, doctors share that there are “reasonable options available” for treatment
2. Options talk
   • Doctors provide additional information on the treatment options and may use other frameworks to help share info
3. Decision Talk
   • Working with patients, listening to goals, and determining the best path forward based on all information available

In general, these strategies have been used more and more in recent years. And, this seems to coincide with patient preference.

A review conducted in 2015 found that 71% of patients preferred to participate in the decision making process as of 2000. This is an increase from the pre-2000 numbers where only 50% of patients wanted to be involved.

As additional models are created and tested, there will be more research exploring the benefits and risks of this approach.