Healthcare providers are being asked to be more “patient-centric” meaning taking time to listen to their patients. “Let the patient tell their story.” They are also being trained on a process called Shared Decision Making. Many decisions have multiple treatment options. Shared Decision Making (SDM) is a process involving two-way communication where patients and providers work together to make decisions based on balancing effectiveness, benefits, and risks of various options with patient values and preferences.
Over the past decade there have been several studies looking at health outcomes when healthcare providers and patients engage in Shared Decision Making. Study results have shown that Shared Decision Making improves health and reduces healthcare costs. When patients are empowered to participate in their healthcare decisions they are more engaged in following through with the plan. Makes sense.
Can you recall the last conversation you had with your healthcare provider about making a change or starting a treatment? Were you told what you should do, for example, start on a patch or gum to quit cigarettes, reduce your calories to lose weight, schedule surgery to remove cancer? OR, were you given all of the treatment options with a discussion of benefits and risks, pros and cons of each option?
I’m writing this blog about Shared Decision Making because this topic is very personal to me. Here’s my story.
Several years ago, I was diagnosed with Graves Disease (simply stated, an overactive thyroid). I was referred to an endocrinologist who told me I needed surgery to remove my thyroid. I was scared, panicked and a bit resistant. Thankfully I delayed surgery. This physician left the practice and I was assigned a new physician. My new physician used Shared Decision Making and listed out and discussed with me all of my options—surgery, radiation, or taking a medication. She told me that over time on the medication my thyroid functioning might return to normal (citing research). I decided on the medication option and after two years on the medication, my thyroid did resume normal functioning. I no longer need to take the medication. Imagine if I had the surgery.
Currently, it’s not yet common for healthcare providers to use this valuable process with their patients. For healthcare providers who are using this approach I say thank you and applaud you (and so do your patients). If your healthcare provider doesn’t use this process, I thought by helping you understand it, you will feel less intimidated to ask specific questions when a healthcare decision needs to be made.
Let me give you an example of how Shared Decision Making works.
Let’s say you were just informed you have diabetes. With Shared Decision Making your provider asks you to participate in deciding on your treatment. (Remember, one option is to choose to do nothing.) You hear, “I’d like you to participate” or “I want to go over all of the options so we can find an approach that works best for you.”
The next step includes going over the options, often using a tool called a “decision aid.” This decision aid is sometimes a simple grid on a piece of paper listing all of the options available, benefits, pros, risks and cons of each option. For diabetes, options would include making no change, losing weight by changing diet and exercise, diet and exercise without weight loss, and starting medication.
The next discussion focuses on what matters to you. With a new diagnosis of diabetes, the patient might weigh in as follows.
“I really don’t want to take medication. I’ve not liked that I gained 20 pounds in the last 10 years. I once exercised a lot and really like to hike and bike ride. My wife said any time I was ready to change my diet she will support me. Now knowing that I have a chance of getting my diabetes under control without medicine, losing weight through diet and exercise is the option is most appealing to me.”
Before asking if the patient is ready to make a decision, the patient is asked if he wants to take time to consult with a family member or support person. And, then the provider asks how the patient wants to proceed with treatment.
“OK, I’d really like to try to change my diet and exercise and lose weight.”
At that point, the provider asks if the patient has questions or needs any additional information. The patient might be referred to a dietitian for help with diet. A follow-up appointment is scheduled to check on how the decision is working, and in this diabetes case, to recheck blood sugar.
If your provider has not been trained in Shared Decision Making, you can still be proactive and ask the following five questions when faced with making a decision about your health.
1. What are all of the treatment options available to me? (remember, not doing anything is an option)?
2. What does the research says about each option’s probability of success for situations similar to mine?
3. What are the benefits and risks, pros and cons of each option? (Share what you consider the pros and cons along with what your provider says.)
4. Is there anything more I can read about for each of these options? (You may also ask for more time before deciding; also time to talk to a significant other about the options.)
5. Can I share with you what is important to me as we talk about these options?
You may also ask the provider what he believes is the best treatment option for you, but do this AFTER you talked through all of the questions listed above.
Bottom Line: Don’t be intimidated by your healthcare provider (most healthcare providers don’t want you to feel intimidated). Participate in your treatment and care by asking the above (and likely other) questions if you are not being asked to participate in your care. You deserve to be heard and to get the care that is right for you.
By Eileen Stellefson Myers, MPH, RDN, LDN, CEDRD, FAND