Shared decision making

What is shared decision making?

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Authors: Nami Nelson, Professor Dawn Stacey, Associate Professor Sophie Hill

This is intended to be a source of practical, evidence based discussion pieces to help people understand and implement SDM in a healthcare setting. The Community of Practice is an important part of the pilot project supported by Safer Care Victoria to train and support eight health services to implement their own SDM projects. The topics for the blog are drawn from common themes and questions asked by the pilot sites as well as relevant literature on SDM.

To start off the series, we wanted to just recap some of the key elements of SDM. To do this we conducted a quick Q&A with respected SDM expert and co-author of the Ottawa Personal Decision Guide, Professor Dawn Stacey, Ottawa University. A necessary first step to understanding how to implement SDM in your healthcare practice is being clear about what SDM actually is. We asked Professor Stacey to help share her responses to a few questions and outline some key definitions and explanations of SDM.

What is SDM?

A process by which decisions are made by the patient (+family) and clinician using:

  • the best available evidence (if available), and
  • patients’ informed preferences.

What is a decision aid?

A decision support tool (paper, online, video) according to the International Standards:

  • Identifies the decision to be made
  • Provides the patient (+family) with information about the options
  • Sets out the pros and cons for each option, including best available evidence (if available)
  • Assists the patient (+family) to clarify their values for each option.

What tips do you have to help people explain to their colleagues what SDM really is compared to existing practice?

SDM is about helping patients understand their options and working with them to choose the best option based on the best available evidence and the option that best fits within their own personal circumstances.

Is SDM about more than just improving patient experience of health care?

Yes, definitely. SDM improves patient experience. But it also makes patients feel like they are part of the team, more comfortable with the option (less decisional conflict), more realistic expectations, and more committed to the chosen option. SDM also has the potential to lower costs when patients learn about other, non-invasive, options for their health condition.

What if the patient makes a decision that isn’t what you would recommend medically?

They can always make that decision (unless it is to have surgery) – but they can always choose to not have surgery or not take chemotherapy or not take a medication to lower their risk of heart disease. So why not help them understand the options and the benefits/harms of the options. According to BMJ clinical evidence review of over 1000 treatments, there are few that are 100% beneficial or 100% harmful. Most treatments require making a trade-off between benefits/harms across options.

In what health service setting is SDM most useful?

All health services in which there are “difficult decisions”. It doesn’t matter if it is in a specialist clinic or a hospital acute or sub-acute ward. As long as, there is a healthcare decision in which there is more than one option (including status quo) and options that patients value differently.

Try these resources as a good starting point to help build an understanding of SDM:

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