How two-way communication and shared decision-making can improve doctor-patient relationships Featured

8:00pm EDT May 26, 2010

In health care, the concept of shared decision-making is becoming more accepted, both by patients and physicians alike. In fact, studies suggest that treatment results improve when doctors and patients work together in medical decision-making.

Shared decision-making has developed in response to the sometimes uneasy relationship between a patient’s right to have input into their treatment options and a doctor’s responsibility to provide the best evidence-based care.

“Shared decision-making recognizes that the best treatment is the one that reflects what is most important to a well-informed patient who understands all the options and the potential outcomes,” says Michael Culyba, M.D., the vice president of medical affairs at UPMC Health Plan.

Smart Business talked with Dr. Culyba about the shared decision-making approach and its importance in health care.

What does shared decision-making mean?

Shared decision-making is a way in which a doctor talks with his or her patient about options and outcomes. In turn, the patient relays his or her opinions about the options resulting in a shared decision about treatment. Preference-sensitive care recognizes that there are trade-offs in the choice of medical care. Shared decision-making also addresses the ethical need to fully inform patients about the risks and benefits of treatments, as well as the need to ensure that patients’ values and choices play a leading role. Most patients willingly participate in shared decision-making, even when decisions are complicated and difficult.

Basically, it comes down to the way in which a doctor would talk with his or her patient about options and outcomes. It is also about how the patient relates his or her opinions about the options. Combined, the result is a shared decision about a course of treatment.

What makes shared decision-making different from traditional medical decisions?

Preference-sensitive care acknowledges that the best treatment is the one that reflects what is most important to the patient when that patient is well informed about the options and potential outcomes. Through the use of shared decision-making, doctors and patients can truly decide on the appropriate treatment. It is an especially useful strategy when there is no clear best treatment option.

Why is it an important concept in health care?

Studies suggest that treatment results improve when doctors and patients work together in medical decision-making. Shared decision-making acknowledges the complex trade-offs in choosing medical care. It also recognizes the importance, if not the ethical need, to fully inform patients about all risks and benefits involved in any treatments. It ensures that the patients’ values and preferences — and not just the physicians’ — need to play a prominent role.

For most patients, the idea of basing health care decisions on shared decision-making is a welcome one. This is true even when the decision involved is complicated and difficult.

Why should employers be interested in shared decision-making?

Preference-sensitive care is most likely to result in what could be called a ‘good’ decision. That is, it is informed, evidence-based, compatible with the patient’s values and it considers patient preferences. Shared decision-making increases the likelihood that patients will be pleased with the process.

For an employer, the shared decision-making method helps to ensure that best practices will be implemented, resulting in the best results and the best value for its health care dollar.

What kinds of conditions are best suited for the preference-sensitive care process?

Conditions such as chronic back pain, early-stage breast cancer and early-stage prostate cancer are examples of conditions that fit well into the model for shared decision-making. The doctor can provide evidence that is based on treatment information and the patient can express his or her goals, concerns and preferences.

How should a patient approach talking with a physician about treatment?

Whenever a patient talks to a doctor about condition and treatment choices, there are a few things to remember. First, the patient should not be afraid or intimidated about asking questions, even ones that reflect a lack of understanding. Patients need to understand what is at stake and a physician should be able to explain it so that it can be understood on some basic level. Also, patients need to be assured that their feelings on this issue do matter and are important. Finally, patients have to understand that while they are being asked to make a decision, sometimes it will be a decision that is made without knowledge of exactly how it will turn out. Sometimes in medicine, patients have to accept some level of uncertainty.

How can a patient prepare for talking with a physician?

There are a few tips that can be followed. First would be to take a list of questions to a doctor visit. Second, if at all possible, bring a friend or family member along on your visit to help you remember concerns and to help you to reconstruct the conversation later. Do not be afraid — or consider it inappropriate or impolite — to take notes. At the end of the visit, recap what you understand and feel free to ask your doctor to summarize for you.

Michael Culyba, M.D., is the vice president of medical affairs at UPMC Health Plan. Reach him at culybamj@upmc.edu or (412) 454-5532.