Shared decision-making is a collaborative process in which healthcare professionals and patients work together to make decisions about the patient's treatment. This approach is particularly significant in managing chronic diseases, where long-term treatment plans and patient adherence are crucial for positive health outcomes.
In a recent interview, David Jayne, MD a clinical nephrologist at Addenbrooke's Hospital, Cambridge UK, provided an exploration of shared decision-making, emphasizing its importance, the barriers to effective implementation, and the benefits it brings to patient care.
Dr Jayne explains that shared decision-making marks a shift from the traditional, paternalistic model of healthcare, where doctors make decisions on behalf of patients, to a more patient-centered approach. In shared decision-making, the physician's role is advisory, presenting patients with various treatment options and involving them in the decision-making process. This partnership empowers patients, enhancing their understanding of their condition and the available treatments. Dr Jayne states, "The physician is primarily in an advisory role, providing patients with options as they see fit."
Education is a cornerstone of shared decision-making. For patients to participate meaningfully in decision-making, they must be well-informed about their condition and treatment options. Dr Jayne points out that better-informed patients tend to have better health outcomes, particularly in chronic disease management.
"The better informed the patient is, the better their long-term outcomes are," he notes. However, he highlights a significant shortcoming in many healthcare systems, including the UK, where patient education is not always prioritized - often due to time constraints. Patients frequently rely on the internet for information, which can be confusing and overwhelming. Dr Jayne suggests that more targeted and accessible educational resources are needed to effectively support shared decision-making.
Several barriers impede the effective implementation of shared decision-making. Dr Jayne identifies three main challenges:
- Resource limitations
- Cultural and educational barriers
- Geographical constraints
Resource limitations mean that healthcare providers often lack the time and training to engage in thorough educational discussions with patients. "It's often a challenge of resource and time," Dr Jayne explains. "Doctors often don't have the time to educate patients to the level required for shared decision-making to be effective."
Cultural and educational barriers can prevent patients from accessing or processing the information they need. Geographical constraints can limit face-to-face interactions, which are particularly valuable for patient education and engagement. Dr Jayne also notes that doctors might not always be the best educators. He suggests that specialist nurses, who often have more time and experience in patient education, could play a more significant role in this process. Additionally, using digital platforms and telemedicine could help overcome some geographical barriers, providing patients with access to essential information regardless of their location.
The application of shared decision-making varies between acute and chronic illnesses. In acute situations, the urgency often limits the patient's ability to participate in decision-making. Conversely, in chronic disease management, there is more opportunity for patient involvement. Dr Jayne mentions that initial acute phases can transition into more collaborative decision-making processes as patients become more familiar with their condition and treatment options. He illustrates this by saying, "If you have something acute, the patient doesn't have the opportunity to learn enough about the options to be able to make an informed decision."
A key element of successful shared decision-making is the involvement of support systems, such as family members or friends. Dr Jayne emphasizes that patients often benefit from having someone accompany them to appointments. "The most important thing is a friend or a partner," he says. This support person can help remember information, ask questions and provide emotional support, enhancing the patient's ability to engage in shared decision-making.
Dr Jayne highlights a significant challenge in patient education: varying levels of understanding and engagement. Some patients may have difficulty grasping medical concepts, while others may prefer to leave decision-making entirely to their healthcare providers. "We know that well over 50%, maybe 70% of what we say goes in one ear and out the other," Dr Jayne remarks. This variability underscores the need for personalized approaches to patient education and engagement.
In conclusion, shared decision-making is a transformative approach in healthcare that fosters collaboration between patients and healthcare providers. While there are challenges to its effective implementation, particularly in resource-limited settings, the benefits of shared decision-making in improving patient outcomes and satisfaction are clear. Education, support systems and personalized approaches are critical components of successful shared decision-making. As healthcare systems evolve, prioritizing these elements will be essential in realizing the full potential of shared decision-making.
Dr Jayne concludes, "Education is always a good thing, and partnership is always better than being on your own."