Shared decision-making

Everyone has preferences - everything from coffee versus tea to more serious ones like buying versus renting . These preferences are particularly important when it comes to your health - for example, do you prefer to take medications which may have side effects or do you prefer to hold off on medications to see if things improve on their own?

Probably depends on the situation, right? Well shared decision making between an individual, their family and the entire healthcare team - helps ensure that an individual’s preferences are respected and prioritized.

And some conditions like breast cancer, prostate cancer, heart conditions, and back pain are especially sensitive to individual preferences.

In fact, informed choices typically lead to better outcomes. Now, to make a well-informed choice, individuals need reliable information about the pro’s and con’s of a treatment option.

That can come from a decision aid like a pamphlet, video, or a website. Let’s take the example of back pain.

Imagine that there’s an elderly woman named Ramona who has been struggling with chronic back pain. She goes online and finds a variety of options - wearing a back brace, trying yoga, surgery, and losing weight - just to name a few - but it’s hard to know what information to trust.

Shared decision making is a process that can help her navigate these choices with a healthcare professional. One approach is called the three-talk model.

The first part is called team talk and it’s where a clinician describes choices, offers support, and asks about an individual's goals.

Ramona shares that she lives alone, but can no longer take long walks or pick up her grandson because of her pain. In fact, that’s the main reason that she’s taking her pain more seriously now.

If she’s feeling supported, Ramona might also discuss being overweight, and how she gets embarrassed having her photograph taken.

The second part of the model is option talk, and it’s where different options are laid out. Her clinician can give her evidence-based decision aids with pro’s and con’s for each option.

Some of these options may be more appealing to Ramona than others. She might be more inclined to work on her diet if she understands that weight loss could help her back pain.

She might really not want surgery because her sister has had chronic pain ever since she had back surgery two years ago.

She might not feel comfortable doing yoga because she feels anxious in group classes with younger men and women, and a back brace seems like it might be uncomfortable.

The third part is decision talk which focuses on making sure that an individual’s preferences are driving that decision.

Ramona might decide to try to change her diet first, and then consider doing yoga or other exercise from the privacy of her home.

She might consider a back brace if those things don’t help, and surgery would be a last ditch option for her. Shared decision making relies on an individual having accurate information and a clear understanding of their situation.

And by spending extra time up front, asking about preferences, and carefully listening, the healthcare team can often uncover beliefs or assumptions that may be motivating that individual’s decisions - and that can save time down the road.

The fact is that clinicians are not very good at guessing what their patients consider important in making their decisions - so these beliefs have to be uncovered through a conversation, so that they can be directly addressed.

Ultimately, If individuals feel that their healthcare professionals understand what they want, they’re more likely to trust the advice they receive.

And better care leads to better outcomes.