What is Shared Decision Making?
Shared Decision Making or “SDM” is a new movement in medicine where providers and individuals collaborate to make decisions together. Gone are the days when uninformed consumers take the word of the doctor as law–shared decision making is a logical reaction to the internet age where we frequently enter the waiting room armed with our own research and ideas. Of course, unless we have a background in medicine ourselves, we may be entering the appointment with outdated information, or our doctor may have information not available to the general public. On the other hand, a doctor may want to pursue a path which opposes the individual’s personal views, religious beliefs or ethical code. Instead of fighting against one another, individual/provider relationships based on SDM can grow together and make final decisions based on the best information from both a medical and personal perspective. (Informed Medical Decisions)
How is Shared Decision Making Implemented?
The Center for Shared Decision Making at Dartmouth-Hitchcock opened in 1999 and offers many resources to facilitate and implement a Shared Decision Making relationship between provider and patient. According to their website, “Our services…include provision of patient decision aids, decision support counseling, and facilitation of advance care planning discussions. Our Patient Support Corps volunteers help patients think about and organize their questions and concerns in preparation for an appointment…” (Dartmouth-Hitchcock) In the spirit of Shared Decision Making, the Dartmouth-Hitchcock site offers resources for both providers and patients to facilitate SDM from both ends.
If you are interested in a relationship with your healthcare provider that relies more on SDM, there are many decision-making tools available for free online. Look through your options before making an appointment with your provider, and come to the appointment prepared to discuss your goals. Be open to asking questions and taking time to make your decisions. In order to foster the SDM relationship, you must be honest with your provider, and answer all their questions completely. Medical symptoms or therapeutic results vary due to many variables–some that may even surprise you. If you read something outside of your appointment that gives you pause or that you want more information on, ask your provider about it. When appropriate, explain your questions and your line of reasoning so that your provider understands you better. Sometimes you may assume a treatment or medication is unnecessary–if you bring those concerns to your provider, they can discuss whether or not that is true.
Important Factors When Changing the Patient/Provider Relationship
The most important word in Shared Decision Making is “shared”. Conversing more with your provider, and opening dialogue more often about treatment, does not mean you should ignore your doctor’s advice or thoughts. The conversation is meant to derive a conclusion which you both agree on, not for the individual to make a decision on their own. While online research and decision aids can help you understand why you want to go a certain route, it is only once you pair that with talking to a provider that any steps should be taken towards treatment (Mayo Clinic).
Shared Decision Making and Telehealth: The Future of Medicine?
Of course a major change in the patient/provider relationship when shifting from traditional to SDM models, is giving more power to the individual. Telehealth also puts more emphasis on the individual than the provider. Telehealth or telemedicine relies on technology not only for delivery of test results and diagnoses, but often for communication between individual and provider. Telehealth or telemedicine allows more individuals to access treatment–those who could not get to a clinic or practice for any variety of reasons can now schedule an appointment on their own time without leaving their home or job.
It logically follows, then, that telehealth and SDM models work together very well, as the patient can deliver information to the provider without having to come in for an appointment. According to C.P. Rosado, in their article “Patient Engagement”, Telehealth and SDM work together to help the individual to feel more comfortable and have better information about their condition as well as possible treatments. “When a patient has access to their own medical records and health data, along with an ability to share that information securely with trusted health partners, they benefit from increased confidence and feel more in control of their own health,” (Fonemed Technology).
Dartmouth-Hitchcock Center for Shared Decision Making. http://med.dartmouth-hitchcock.org/csdm_toolkits.html
Patient Decision Aids, The Ottowa Hospital. https://decisionaid.ohri.ca/index.html.
Rosato, C.P., Patient Engagement: Changing Definitions and Roles, Fonemed Technology. http://www.fonemed.com/wordpress/telehealth-patient-engagement/
Shared Decision Making Philosophy, Mayo Clinic. http://shareddecisions.mayoclinic.org/decision-aid-information/decision-aids-for-chronic-disease/
Why Shared Decision Making?, Informed Medical Decisions. http://www.informedmedicaldecisions.org/shareddecisionmaking.asp
What is Telehealth?, Center for Connected Health Policy. http://cchpca.org/what-is-telehealth