COMMENTARY

What Stands in the Way of Shared Decision-Making?

Tom G. Bartol, MN

Disclosures

June 14, 2019

Shared Decision-Making

Even when faced with a serious chronic or life-threatening disease, patients don't always agree with the treatments recommended by healthcare providers.

An example can be found in the world of oncology, where complex and consequential treatment decisions must be made every day. Shared decision-making is a patient-centered approach that ensures patient involvement in treatment decisions. But how well does this process work?

A recent industry-funded systematic review[1] examined shared decision-making in oncology care. The review comprised 35 studies involving patients with breast, prostate, gastrointestinal, or lung cancer to identify the barriers and facilitators to shared decision-making.

Three impediments to shared decision-making were consistently recognized:

  • Uncertainty or lack of consensus in the treatment decisions;

  • Patient concerns about adverse effects of treatments; and

  • Poor physician communication.

Physician communication was the barrier to shared decision-making most frequently identified across all studies. Examples of communication deficiencies included not sharing all treatment options with the patient, providing lengthy monologues about treatment without verifying patient understanding, using overly technical language, and failing to address such topics as hospice, living wills, spiritual concerns, and life support preferences.

The review also identified factors that facilitated shared decision-making. These were:

  • Physician consideration of patient preferences;

  • Positive physician actions/behaviors (caring, trusting, relationship building, strong communication); and

  • Use of, or encouragement to use, support systems.

Treatment decisions were more likely to be explored when the physician understood the patient's needs, values, and goals, increasing the trust between them. Seeking support from sources other than the physician (such as family, friends, and support groups) also facilitated shared decision-making.[1]

Viewpoint

Understanding the barriers and facilitators of shared decision-making can improve oncology care and manage expectations about cancer treatment.

Communication and trust are the essence of shared decision-making. This can be a challenge for any healthcare provider who abruptly enters a patient's life after a new, potentially life-threatening diagnosis, when the patient's overriding emotion is fear.

Although this study focused on cancer drug treatment decisions, the findings have broad applicability in healthcare. According to Covvey and colleagues,[1] emerging evidence suggests that the value that shared decision-making provides extends beyond individual patients to benefit the healthcare system as a whole.

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