COMMENTARY

Shared Decision-Making in Chronic Care

Tom G. Bartol, NP

Disclosures

February 10, 2015

Shared Decision Making in Chronic Care in the Context of Evidence Based Practice in Nursing

Friesen-Storms JH, Bours GJ, van der Weijden T, Beurskens AJ
Int J Nurs Stud. 2015;52:393-402

Shared Decision-Making

This qualitative review explores the relevance of integrating shared decision-making to evidence-based practice while examining different models that nurses can use with patients who have chronic conditions. Evidence-based practice is often translated into clinical practice guidelines. These guidelines often focus more on carrying out the guideline and less on the individual patient's values in the decision-making process.

Shared decision-making aims to have the healthcare professional and the patient jointly arrive at a healthcare decision. In chronic care, shared decision-making can enhance self-management, self-efficacy, and patient empowerment.[1] Nurses can help patients make healthcare choices by sharing evidence and information while helping them to integrate their individual needs, goals, and values.

There is a legal obligation for informed consent in healthcare treatment, but the patient's input into decision-making is not a required component of informed consent. Healthcare has often used a paternalistic approach to medical decisions, with the healthcare professional making the decision and then informing, and sometimes convincing, the patient that this would be the best approach.

One model of shared decision-making uses a three-step process:

Choice talk: makes patients aware of available options;

Option talk: providing detailed information about options; and

Decision talk: supporting the process of deliberating on the best option.[2]

Shared decision-making has often been advocated when there is no clear evidence on the best treatment decision or screening option. In chronic care, however, even if evidence is strong for a certain option, there are other considerations when choosing an option, including the effects on lifestyle, quality of life, side effects, resource utilization, and patient values. Although patients may find it unusual to be asked to be involved in decision-making, they often become more comfortable with the process once they are involved in it.

Patients' level of willingness to participate in the decision-making process can be influenced by several factors. They are more likely to want to participate after the acute stage of the disease rather than during it. Younger patients prefer shared decision-making more than older patients. People with higher levels of education are more open to sharing decisions than those with lower education levels. The research shows that patients want more involvement in decision-making than what typically occurs now, so it is important for nurses to explore a patient's desire to be involved in the decision-making process.

The essential requirements for effective shared decision-making are good communication skills to establish rapport, knowledge to provide information about the risks and benefits of a decision, and the ability to understand the patient's values and preferences. Providing nurses with training in shared decision-making will help them to integrate shared decision-making with evidence-based practice to deliver patient-centered care and involve patients in the decision-making process.

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