The Challenges and Opportunities for Shared Decision Making Highlighted by COVID-19

Abstract

Shared decision making (SDM) is a management paradigm that empowers patients as partners in their own care in a bidirectional exchange of information and values, and optimize the decision-making process. During the current coronavirus disease 2019 pandemic, there is a greater need to encourage participation in the SDM process. The pandemic has created both challenges and opportunities for delivering care, as system adaptations influence the physician-patient relationship. Although social distancing and health service reallocation can interfere with preference for an in-person visit, these measures also provide an avenue to study and implement virtual SDM processes. Communicating risk at a time of heightened uncertainty may pose a barrier to SDM engagement but provides the opportunity to foster a patient-centered approach within a more personalized context. Social media influence during coronavirus disease 2019 has resulted in an “infodemic” but highlights the importance of patient engagement. The pandemic has changed how we deliver care but allows us to re-evaluate common practices and enhance effectiveness of our management strategies. Navigating the uncertainty of subsequent pandemic waves creates confusion about how to safely reinitiate clinical service. This will require ongoing SDM with our patients and among colleagues through current—and future—challenges. Coronavirus disease 2019 has created many difficulties but has forced us to reexamine how to provide more patient-centered and high-quality care.

Pediatric asthma and COVID‐19: The known, the unknown, and the controversial

“…The American Academy of Allergy, Asthma and Immunology notes no evidence that immune response to COVID‐19 will be impaired in patients with asthma on biologic therapies and that it would be “reasonable” to continue administration of biologics in patients with asthma, 37,38 a recommendation supported by several international allergy/pulmonology organizations including the British Thoracic Society, and the Italian Society of Allergy, Asthma and Clinical Immunology 39,40 . These organizations also support home‐based administration of biologics when possible, an approach that improves access and is cost‐effective 38,41,42 …”

“…For children with recent asthma exacerbations, an in‐person visit may be beneficial, assuming access to personal protective equipment 20 . At present, a shared decision‐making approach with effective risk communication may provide opportunities for improved delivery of care, allowing care providers to re‐examine how we deliver care and enhance the effectiveness of our management strategies 42 …”

Ethics of kidney care in the era of COVID-19

“…In the clinical setting, there may be several practical barriers to SDM during the pandemic as a result of, for example, reliance on telemedicine or physical distancing measures in clinics. 43 These may raise ethical concerns about respect for patient autonomy and complicate efforts to determine the best interests of patients who lack decision-making capacity. 44 For example, if a patient who communicates nonverbally is hospitalized and COVID-19 protections prevent the attendance of their usual carers, video calls may be ineffective in enabling carers to ascertain the views and preferences of that patient through visual cues.…”

“…12 Use 5 443 444 445 446 447 448 449 450 451 452 453 454 455 456 457 458 459 460 461 462 463 464 465 466 467 468 469 470 471 472 473 474 475 476 477 478 479 480 481 482 483 484 485 486 487 488 489 490 491 492 493 494 495 496 497 of patient and clinician decision aids, which comprise various structured tools designed to support evidencebased and deliberative decision-making, may help manage decision-making difficulties and promote the dialogue necessary for effective SDM. 43,45,46 Effective staff training and support for SDM, tailored to the new clinical realities of the pandemic era, will be essential to ensure that any decision-making aids are used effectively. Clinicians will need to cautiously and critically evaluate evidence from experiences in different countries or health system contexts for application in their local setting and may benefit from additional training in risk communication and SDM with patients (see Table 3).…”

Novel Approaches to Food Allergy Management During COVID-19 Inspire Long-Term Change

“…Physicians must keep an open mind when educating patients and gain a clear understanding about what matters most to them. 22 , 23 The COVID-19 pandemic is an opportunity to better understand early introduction trade-offs and to find a balanced approach to enhance implementation.…”