Brought to you by: What is Shared Decision Making? Why is it important?

Larry Morrissey Pediatrician (who happens to work with Prostate Cancer) Medical Director for Quality Improvement Stillwater Medical Group Chair, Minnesota Shared Decision Making Collaborative (MSDMC)

Why Bother With SDM?

Patient Centered Care Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions. -The Institute of Medicine: Crossing the Quality Chasm

The Patient as the Source of Control Give the necessary information Give the opportunity to exercise the degree of control they choose over health care decisions that affect them Accommodate differences in patient preferences Encourage shared decision making Institute of Medicine Crossing the Quality Chasm

What is shared decision making? Attitude Process Tools

Key Components of SDM Knowledge Know that there are options including doing nothing Discuss Risks Discuss Benefits Understand patient preferences and values and include them in the discussion

What is informed consent? It is a process of communication between a patient and physician that results in the patient's authorization or agreement to undergo a specific medical intervention. Has similar elements to SDM Knowledge, alternatives, risks, benefits Both an ethical obligation and a legal requirement spelled out in statutes and case law in all 50 states. Source: AMA website

Think of when you bought one of these.

How SDM goes beyond Informed Consent Collaborative decision making—decide together vs. accept or reject recommendation Giving the patient the best chance to be adequately informed Explicit clarification of preferences and values Avoidable decision conflict surfaced and resolved Taking the time to make a good decision Informed consent is the legal “closing” of the deal

Why is SDM important? Decisions are often complex Patients want to make a good choice Decisional conflict often exists Nature of the decision will affect our goals Variation exists in motives for supporting it Ethical Efficiency Effectiveness

Ethical Imperative The strongest case Respect the autonomy of the patient Address the balance between helping and not doing harm Avoid the danger of undeclared uncertainty A person cannot express their preferences if they do not know the choices they have

What is the nature of the intervention? Effective Care Large benefit Minimal harms Good evidence Preference Sensitive Care Alternatives exist with no clear best choice Depends on personal values How important are the benefits versus the harms?

What is a “Quality” Decision? The goal is an informed decision that is based on patient values and evidence. However: Knowledge cannot be assumed Benefits and risks are not presented equally We can make unwarranted assumptions about patient preferences and actions

An Important Challenge for Shared-decision Making What outcomes do we expect? Should we expect? Lower costs (i.e. Commonwealth report) Reduce non-adherence Knowledge transfer Decrease liability (i.e. an enhanced informed consent) Should we take a more simple approach? “It’s the right thing to do.” How do you actually do this well in everyday practice?

Barriers that Clinicians Fear Time Cost Another thing to do I already know/do this Resistance to the results Difficulty with change of our role Being afraid to take risk How fast can this go from a good idea to a proven way of improving the lives of our patients?

How do we make informed decisions based on medical evidence and patient values something people experience all the time?

“ Each one of us matters, has a role to play and makes a difference.” - Jane Goodall Step one: You can inspire change!

Help them with the ride