Potential Unintended Consequences Of Recent Shared Decision Making Policy Initiatives

Abstract

Shared decision making (SDM)-when clinicians and patients make medical decisions togetheris moving swiftly from an ethical ideal toward widespread clinical implementation affecting millions of patients through recent policy initiatives. We argue that policy initiatives to promote SDM implementation in clinical practice carry the risk of several unintended negative consequences if limitations in defining and measuring SDM are not addressed. We urge policy makers to include prespecified definitions of desired outcomes, offer guidance on the tools used to measure SDM in the multitude of contexts in which it occurs, evaluate the impact of SDM policy initiatives over time, review that impact at regular intervals, and revise SDM measurement tools as needed.

Five Golden Rings to Measure Patient‐Centered Care in Rheumatology

“…A recent publication reflecting on the implications of policy changes in the realm of SDM raised the issue that current SDM measurement tools may have limitations in the context of longitudinal decision‐making processes in chronic care conditions, such as arthritis . Many measures and decision‐support tools are designed for one‐time decisions, such as whether or not to have joint replacement surgery, and, therefore, fall short for the types of conversations taking place over time in situations faced by persons with chronic diseases . This is, in part, the rationale behind our selection of tools that have a broader reach and that capture concepts such as trust and empathy .…”

“…Many measures and decision‐support tools are designed for one‐time decisions, such as whether or not to have joint replacement surgery, and, therefore, fall short for the types of conversations taking place over time in situations faced by persons with chronic diseases . This is, in part, the rationale behind our selection of tools that have a broader reach and that capture concepts such as trust and empathy .…”

“…Recent years have seen advancement in the conceptualization of patient‐centered care, which has enabled measurement of specific dimensions. Many questions remain unanswered, such as the impact of health literacy on the psychometric properties of these tools or optimal methods to involve patients in quality improvement initiatives of clinician‐patient communication in rheumatology . Measurement of patient‐centered care is a dynamic field of research with many opportunities.…”

Envisioning Shared Decision Making: A Reflection for the Next Decade

“…48 Such policies devalue SDM, reducing it from a form of care to a tactic to reduce liability, to correct the over-or underuse of tests and treatments, and to reduce costs. 49 When SDM is considered as a procedure, separate from care, it is possible for a health care organization to deploy this procedure in a standardized way (e.g., embedding SDM tools in the electronic record for patients to review in preparation for key appointments). These efficiencies often require seeing what is common about patients and their situations rather than what is particular.…”

Evolving surgical management of pediatric vesicoureteral reflux: is open ureteral reimplantation still the ‘Gold Standard’?

“…Shared decision making, the collaborative process of clinicians and patients (or parental surrogates) making medical decisions together, takes into consideration not only risks and benefits of a given intervention, but also the preferences, goals, and concerns of the family before arriving at a decision (45). Perhaps nowhere is this concept more relevant in pediatric urology than in diagnoses of primary VUR, where 'optimal' treatment remains heavily debated and a universal management algorithm is lacking.…”