Envisioning Shared Decision Making: A Reflection for the Next Decade

Abstract

Despite the evolving evidence in favor of shared decision making (SDM) and of decades-long calls for its adoption, SDM remains uncommon in routine care. Reflecting on this lack of progress, we sought to reimagine the future of SDM and the path to take us there. In late 2017, a multidisciplinary and international group of six researchers were challenged by a senior SDM scholar to envision the future and, based on a provocatively critical view of the present, to write letters to themselves from the year 2028. Letters were exchanged and discussed electronically. The group then met in person to discuss the letters. Since the letters painted a dystopian picture, they triggered questions about the nature of SDM, who should benefit from SDM, how to measure its contribution to care, and what new ways can be invented to design and test interventions to implement SDM in routine care. Through contrasting the purposefully generated dystopias with an ideal future for SDM, we generated reflections on a research agenda for SDM. These reflections hinged on recognizing SDM’s contributing to care, that is, as a way to advance the problematic human situation of patients. These focused on three distinct yet complimentary contributors to SDM: 1) the process of making decisions, 2) humanistic communication, and 3) fit-to-care of the resulting decision. The group then concluded that to move SDM from envisioned to routine practice, and to ensure it reaches all, particularly persons rendered vulnerable by current forms of health care, a substantial investment in implementation research is necessary. Perhaps the discussion of these reflections can contribute to a path forward that will improve the likelihood of the future we dream for SDM.

Midwives’ empathy and shared decision making from women’s perspective - sensitivity of an assessment to compare quality of care in prenatal and obstetric care

“…In general, across both care settings, women appear to rate the midwife’s empathy better than the midwife’s SDM behavior. Although SDM effects are well documented in health services research and the concept is considered a central component of high-quality patient care, implementation in routine care is lacking [ 55 ]. SDM is often considered an add-on to discipline-specific care delivery in the care setting.…”

“…SDM is often considered an add-on to discipline-specific care delivery in the care setting. Here, clarification is needed on whether the use of standardized procedures can simplify SDM processes and facilitate the efficiency of procedures to ensure women’s rights [ 55 ]. This marks a starting point for clinical practice to align maternity care more closely with women’s needs [ 56 ].…”

Acceptability of, and preferences for, remote consulting during COVID-19 among older patients with two common long-term musculoskeletal conditions: findings from three qualitative studies and recommendations for practice

“…Recently, the Patient Information Forum reported that in the UK, 1.7 million people are unable to explain symptoms or feelings on the phone [ 22 ]. This is likely to impair the quality of patient-clinician shared decision-making and widen existing health inequalities and these challenges are likely amplified by low health or digital literacy, hearing, visual, or cognitive impairment or language barriers [ 23 – 26 ], commonly experienced by older adults [ 6 ]. Studies have continued to highlight patient and clinician preferences for face-to-face consulting, with evidence that clinicians want to see and examine patients with RA [ 21 , 27 – 29 ].…”

Overscreening for Women’s Cancer: Time for Change

“…21 I was participating in shared decision making, which, although promoted for decades, remains uncommon in routine care. 22 Materials for clinicians are readily available (such as the USPSTF guidelines on shared decision making and decision aids), 23 but there are impediments such as economic constraints and determining which interventions warrant shared decision making in busy practices. 24,25 Sufficient consultation time, increasingly in short supply, is a necessity.…”