Shared Decision-Making Leads to Better Health Outcomes, Lower Costs, Two Experts Say

Article excerpt

Giving patients more say in their medical treatment choices -- a health-care innovation called shared decision-making -- improves outcomes and saves money, according to an article published online Friday in the Atlantic magazine.

"The habit of assuming the doctor knows best has created a system where huge numbers of patients aren't getting the treatment they would have chosen if they were fully informed," write the article's authors, Shannon Brownlee and Joe Colucci of the New American Foundation. "It also means that hundreds of thousands of patients are going through surgery that wasn't really worth it, and that they wouldn't have chosen had they understood their options."

How exactly does shared decision-making work? Here is Brownlee and Colucci's explanation:

Shared decision making is a way of dealing with the tough questions posed by "preference-sensitive conditions" -- conditions where there are multiple treatment options, and none of those options is clearly better than the others. That includes conditions like arthritis in knees and hips, low back pain, stable angina (chest pain from heart disease), and early-stage prostate and breast cancer. (Obviously, it doesn't include emergency conditions like heart attacks and hip fractures, or conditions where there is clearly only one treatment.)

Deciding on a treatment for preference-sensitive conditions involves weighing a variety of risks and possible benefits, and different patients will end up making different "right" decisions because they have different values and preferences. The best example here is women with early-stage breast cancer. They can choose lumpectomy (surgery that preserves the breast) or mastectomy (which removes it entirely). The two options are equally good in terms of reducing the risk of dying of breast cancer, but they require different kinds of follow-up and different women prefer one over the other.

Making such decisions means that patients must have the relevant information about all their treatment options, and doctors must understand their individual patients' preferences -- basically, what they want from treatment. But too often, patients only hear about one treatment option, the one the doctor usually uses -- and doctors routinely assume they know what their patients want without actually asking them. And in many cases, the doctor is wrong.

'Patient decision aids'

A common but not essential part of the shared decision-making process, note Brownlee and Colucci, is the use of "patient decision aids" -- written materials or videos, which can be accessed either online or off. …