Thursday, December 12, 2013

Shared Decision Making Requires Effort, Data, and a Proper Mindset

---Terri Bernacchi, PharmD, MBA,  Cambria Health Advisory Professionals, Senior Partner at Valiant Health, SME Systems

Patients (and their family members) frequently must make choices about treatment alternatives. In order to do this, they be able to weigh the benefits or risk of each option. The doctor may already hold a bias in terms of what needs to be done for a patient (surgery, medication, “watchful waiting”).  The doctor certainly holds the advantage in terms of his/her understanding of the disease, the options, and the power to enact a decision.  But often, the doctor is missing a vital piece of the puzzle: what the patient is really doing at home, what they want, what they fear, and what they can afford.  Without such insights, he or she cannot fully appreciate how the pain or disability is affecting the patient and family on a day-to-day basis. Nor does he understand how the disease is impacting a person’s spiritual and physical needs and wants.
If you believe that it is ultimately NOT the doctor’s decision, then you believe in “shared decision making” (SDM) and the patient’s choice in regard to what happens to him or her.  If there are any risks or ongoing pains involved in a treatment option, or if personal behaviors can make the outcome better or worse, it’s best that the patient appreciate them.
Shared decision making requires, above all, an open and honest communication between the patient, the family, and the doctor.  SDM requires EFFORT on the part of all parties; the doctors and nurses cannot do magic without the active involvement of the patient and family.  They need to be guided by DATA that (using the best information available at the time) assists them in calculating risks, rewards, and likelihoods of success for one option over another.  Last, SDM requires a fundamental shift in the patient’s and provider’s mindset.  If a patient expects that the doctor can simply make all the decisions and they can be passive in their own care, they will likely encounter the least favorable outcomes.
“Many Americans don't have enough information or education to make fully informed choices about healthy lifestyles, medical treatments or navigating the complex U.S. healthcare system. Poorly prepared patients can be overwhelmed by new information that follows a diagnosis. “When patients are in doctors' offices, they (might) hear 50% of what's being said and maybe their relative hears another 30%, but they walk away without 20%,” North Shore-LIJ's Vignola said.”  See:  Modern Healthcare Article,” Providers help patients address emotion, money, health literacy” by Melanie Evans.   http://www.modernhealthcare.com/article/20131210/INFO/312129978/channeling-choice-providers-help-patients-address-emotion-money

Clearly, the Institutes of Medicine and other governmental entities and academicians are starting to study the impact of SDM in health care.  More literature is coming out and the case for actively-involved patients is beginning to be better understood.  But it’s a long way till we arrive at the finish line.

Terri is a Senior Partner at Valiant Health, LLC, and founder of Cambria Health Advisory Professionals and a Managing Partner at Quo Magis partners.  The thoughts put forth on these postings are not necessarily reflective of the views of her employers or clients nor other Valiant Health colleagues. Terri has had a varied career in health related settings including: 9 years in a clinical hospital pharmacy setting, 3 years as a pharmaceutical sales rep serving government, wholesaler, managed markets and traditional physician sales, 3 years working for the executive team of an integrated health system working with physician practices, 4 years as the director of pharmacy for a large BCBS plan, 12 years of experience as founder and primary servant of a health technology company which was sold to IMS Health in late 2007.  She has both a BS and a PharmD in Pharmacy and an MBA.