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Supporting Shared Decision Making in Your Practice

This document explores the importance of shared decision making (SDM) in healthcare, illustrating its value when patients face complex choices. Case studies highlight a 57-year-old woman deciding between radical mastectomy and lumpectomy with radiation, and a 51-year-old man contemplating a PSA screening. Additionally, it discusses a 35-year-old woman with depression, weighing medication, psychotherapy, and watchful waiting. SDM empowers patients by providing critical information and allowing them to engage meaningfully in their treatment decisions, ensuring their values and preferences are prioritised.

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Supporting Shared Decision Making in Your Practice

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  1. Supporting Shared Decision Making in Your Practice Peggy Chausse Neil Korsen PRISM #5 May 8, 2008

  2. A 57 year old woman had a screening mammogram which showed a suspicious area. Biopsy showed malignant cells. • How would you advise her regarding her choice of surgical approach? • Radical mastectomy • Lumpectomy and radiation

  3. A 51 year old man is trying to decide whether to have a screening PSA done. How would you advise him on the pros and cons?

  4. A 35 year old woman screens positive for depression with a PHQ-9 score of 13. She has no previous history of depression. She reports that her function is very impaired by her symptoms. She is not suicidal. What treatment would you suggest? • Medication • Psychotherapy • Watchful waiting

  5. Shared Decision Making • Shared decision making is the collaboration between patients and caregivers to come to an agreement about a healthcare decision. It is especially useful when there is no clear "best" treatment option.

  6. Shared Decision Making • The caregiver offers the patient information that will help him or her: • Understand the likely outcomes of various options • Think about what is personally important about the risks and benefits of each option • Participate in decisions about medical care

  7. Preference Sensitive Care • Preference sensitive care refers to those conditions in which there are tradeoffs between benefits and risks for the patient, or the benefit/risk information is incomplete. • Patients and families, with good information, are more able to make good decisions in these situations than clinicians.

  8. 2 fold variation

  9. Resources – “Show and Tell” • Health Dialog/Foundation for Informed Medical Decisions www.healthdialog.com • National Council on Patient Information and Education www.talkaboutrx.org or www.bemedwise.org • Agency for Healthcare Research and Quality www.ahrq.gov/consumer

  10. Resources • Ottawa Personal Decision Guide www.decisionaid.ohri.ca/decguide.html • The Center for Shared Decision Making, Dartmouth-Hitchcock Medical Center www.dhmc.org/shared_decision_making.cfm • MaineHealth Learning Resource Center www.mainehealth.org

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