Patients’ voices are made to matter through shared decision-making
Bridging the knowledge gap, study finds physicians supportive of including patients to guide their own care.
Call it the Dr. Google effect. Thanks to today’s search engines, seemingly boundless internet, and social media, people who are not medical professionals are better equipped than ever to investigate the symptoms, illnesses, and conditions that ail them. According to Vancouver Coastal Health Research Institute scientist Samantha Pollard, such availability and accessing of health-related information are partly why health care is becoming more patient-centred and shared decision-making (SDM) between patients and physicians is increasingly being supported by public health policy.
“There’s been a paradigm shift from a somewhat paternalistic type of patient-physician relationship to one in which patients want to take a more active role in their care,” says Pollard, a trainee with the Centre for Clinical Epidemiology and Evaluation (C2E2) and PhD candidate at the University of British Columbia School of Population and Public Health.
“And it seems as though health policy is responding to that, in one way, by talking more about shared decision-making.”
SDM can be defined as an encounter, or multiple encounters, wherein a patient and his or her physician, or care team, come together and the patient is part of the decision making process around treatment. Through SDM patients are seen as partners in their own care, helping inform the decision making process by sharing what is important to them, such as their values, lifestyle, treatment preferences, etc. The final component of this encounter has both patient and physician come to a mutually agreed upon statement so that both are satisfied with the choice of treatment and the patient understands why they are on that course of action. Ideally, SDM will improve various types of health outcomes.
Pollard’s study, “Physician attitudes toward shared decision making: A systematic review”, published in Patient Education & Counselling, sought to find the opinions of physicians around using SDM in clinical practice and to identify clinical areas that garnered the highest levels of support for SDM.
Pollard found that while physicians reported positive attitudes toward SDM in clinical practice, their levels of support varied depending on the clinical scenario, treatment decision, and patient characteristics. For example, clinical scenarios in which multiple treatment options existed had higher levels of SDM support from physicians. Doctors were also more supportive of SDM in situations in which the physician perceived that the patient was willing and cognitively able to be engaged in their care.
The combination of medical advice and patients' preferences are more likely to support treatment decisions that lead to the health outcomes that patients value.
While physicians reported being open to SDM, Pollard explains that it is not happening to the extent one would expect, perhaps because there is lacking information about physicians’ attitudes around it.
“We wanted to fill that knowledge gap by looking at what physicians think because in order for SDM to move ahead, you have to have support from both physician and patient – everyone in the room,” she says.
Building on these findings, Pollard’s current research seeks to uncover possible reasons for lack of support, or in what clinical scenarios physicians are supporting or not supporting SDM.
“In order to change what’s happening now, and perhaps influence physicians in implementing a new structure to clinical encounters or adding something new when they’re seeing their patients, it would be helpful to provide them with a broader evidence base on this topic,” explains Pollard. “Looking into this could also lead to the development of strategies for uptake such as exposing more medical students to SDM in their residency.”
“Seeing that physicians appear to be supportive of SDM, at least in theory, offers a promising first step, although additional evidence regarding outcomes associated with SDM may be required to garner further policy uptake.”
C2E2 Rounds are presented Mondays from 12:00 pm to 1:00 pm in room 700 of the VGH Research Pavilion, 828 West 10th Avenue, Vancouver, BC.
Oct 21, 2019 // Heather McKay
Nov 18, 2019 // Chris Lovato & Craig Mitton