Are systems in place to support shared decision-making?

Are systems in place to support shared decision-making?

When they are fully informed patients often make treatment decisions that are more conservative and lower cost than those chosen by their physician.

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According to Professor Al Mulley of the Dartmouth Institute, there is a widespread failure by clinicians to properly understand the preferences of their patients and how the proposed interventions will affect their lives.1

He calls this 'preference misdiagnosis' which wastes resources and can harm patients.

"There is also growing concern that there is an increasing amount of ‘over-diagnosis’ in which patients are over investigated and screened and may be harmed as a result. An informed patient that is aware of the risks may be less likely to agree to these procedures and as a result is more likely to get an outcome they will be content with."

There are a number of advantages to this approach. Patients often make different decisions about their care when they are fully informed about their treatment options – often more conservative and lower cost than those chosen by their physician.

Developing the skills to involve patients in decision-making, training staff or developing health coaches, providing decision aids and documenting and tracking preferences are key competences.

Our research on patient organizations showed that medical professionals would like to involve their patients but feel they did not have the time.

"Most GPs say they'd love to do shared decision-making but they don’t have the time. We need to think more carefully about how we can liberate people to do the right thing, to see that integrated care is better care, that it can help professionals and delivery organizations as well as patients."

– By Jeremy Taylor, National Voices, UK

Not having the time to work with patients to reduce the demand for healthcare will almost certainly cost resources.

A key area that is highlighted as one of the characteristics of low cost high quality organizations is that they spend time and care to help patients plan ahead – including advanced planning for the end of life. This is an area where a large amount of high cost but often futile care is delivered because the appropriate conversations did not take place at the right time.

The way in which healthcare organizations talk about whether patients take their medicines or not (the language of compliance or adherence) shows how little thought has been given to the patient as a consumer of services and medicines. No consumer orientated industry would expect its consumers to 'comply' with the industries wishes – they would have an approach that recognized the power of the consumer over their own choices.

There is also growing concern that there is an increasing amount of 'over diagnosis' in which patients are over investigated and screened and may be harmed as a result.

Footnote

  1. Mulley A, Trimble C, Elwyn G. Patients' Preferences Matter: stop the silent misdiagnosis. King's Fund. 2012

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