How sharing decision-making power can raise quality and reduce cost in health care

Stephen Perkins, Vice president, Medical Affairs, UPMC Health Plan

Shared decision making in health care can be simply defined as decisions that are shared by doctors and patients. These decisions are informed by the best evidence available and are weighted according to the specific characteristics and values of the patient.

In 2010, a study in the New England Journal of Medicine reported lower costs and fewer hospital admissions when patients were given shared decision-making tools to help understand their options and the consequences of those options.

“Shared decision making acknowledges that there is no single right answer for everyone and that medical decisions involve value judgments,” said Dr. Stephen Perkins, vice president of Medical Affairs for UPMC Health Plan. “Shared decision making doesn’t mean that the physician’s opinion does not matter in the ultimate decision. It means that the patient’s opinion will be given weight when a real choice is available.”

Smart Business spoke with Perkins about the concept of shared decision making and how it can be a force to raise quality and reduce cost in health care.

Why is shared decision making gaining acceptance?

Shared decision making encourages physicians to include, as part of their treatment routine, consultations with patients about options and outcomes. This gives the patient an opportunity to offer an opinion about those options and can result in a shared decision about treatment.

Both physicians and patients are increasingly coming to see the value of this. When decision making is shared, there is more comfort and satisfaction by the patient with the treatment decisions. This can lead to a greater acceptance of responsibility and engagement in developing and executing long-term treatment plans, which can lead to improved long-term health outcomes.  As a result, there is a reduction of wasteful spending associated with noncompliance.  Shared decision making can reduce wasteful spending because instead of physicians driven to practice ‘defensive medicine,’ ordering tests primarily to avoid potential lawsuits after the fact, physicians and patients can agree on a course of action beforehand and commit to that.

What are the barriers to shared decision making?

Shared decision making can be difficult because it balances two elements that can be in opposition to one another. One is the patient’s right to have input into treatment options, the other is a physician’s responsibility to provide the best evidence-based health care. Time is also an obstacle. Both physicians and patients may believe that they do not have the time necessary to go over all care choices.

What are some of the advantages of shared decision making?

If a decision is truly shared, there is a greater chance that it will increase patient satisfaction, which can lead to decreased anxiety and a quicker recovery because there is a greater likelihood that there will be full compliance with treatment regimens.

When shared decision making is done correctly, the treatment course will reflect what is most important to a patient who is well-informed and who fully understands all options and all of the potential outcomes of treatment. In addition, greater patient involvement in decision making often leads to lower demand for health care resources.

What does shared decision making look like?

The American Medical Association has recognized three core elements that need to be part of shared decision making: clinical information, values clarification, and guidance and communication.

Clinical information includes a synthesis of relevant scientific evidence about the patient’s medical condition, the available treatment options and the risks, benefits and outcomes associated with each option. Values clarification is a presentation of the more subjective elements of the patient’s condition and treatment options. This may require testimonials from actual patients and a questionnaire-type tool to help patients articulate their priorities.

Guidance and communication means providing the help and guidance needed in order for patients to make decisions with which they are comfortable. In short, the patient needs to be fully informed and fully engaged, and the final decision needs to involve both patient and physician.

A growing body of research indicates that both patients and physicians benefit when patients are well informed and play a significant role in deciding their treatment. Because any shared decision is more likely to match patient preferences, values and concerns, patients are more likely to stick with treatment regimens and experience better health afterward.

What is required of the patient in shared decision making?

The patient must not be too intimidated by their doctor to ask questions. The patient should not be shy about expressing personal feelings; they matter in this process. A patient must also come to grips with the idea that there are times when medical decisions need to be made, without complete assurance as to how they will turn out.

Patients can maximize the value of their physician visits by bringing a list of questions with them, by bringing a friend or family member to help them remember concerns, by taking notes, and by asking your doctor to summarize what you talked about at the end of the session.

Dr. STEPHEN PERKINS is vice president, Medical Affairs for UPMC Health Plan. Reach him at (412) 454-7682 or [email protected]

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