Shared Decision-Making: Why does it matter?

By Ginny Weir, MPH

Program Director, Bree Collaborative

You deserve to be actively involved in your health. Your health care team should treat you as a partner and work with you to decide what type of care or treatment is best. This is why shared decision-making is so important. Shared decision-making is a way for you and your health care providers to talk about choices and decide together what is right for you.

Shared decision-making uses tools, called ‘patient decision aids,’ to help you and your health care providers make decisions together. These tools help to balance scientific evidence and your personal values: what is important to you. They can help explain the background of a disease or condition. They should be based on available evidence, discuss any potential harms and the benefits of treatment, and help you think through your values.  Most important, they should be easy to understand.  These aids can also include stories from patients like you: patients who have had the same diagnosis or been in the same situation. According to studies, patients using these type of tools with their doctors had more knowledge about their health care conditions, understood the risks and benefits of treatment, had less anxiety, and were more likely to get the type of care they wanted.[1]

Our State defines shared decision-making aids, or patient decision aids as “a written, audio-visual, or on-line tool that provides a balanced presentation of the condition and treatment options, benefits, and harms including, if appropriate, a discussion of the limits of scientific knowledge about outcomes. They include a means to acknowledge that the tool has been fully reviewed and understood.”[2]

What is the Bree Collaborative?

The legislation that created the Bree Collaborative made sure to name shared decision-making aids as an important part of what we should think about when we make our recommendations about any health care topic.

Our Collaborative is a dedicated group people appointed by the Governor; they look at health care services or topics such as low back pain that might have bad outcomes for patients such as pain, exposure to radiation, or infections; that are expensive but do not result in better care or patient health; or where the care you receive varies from doctor to doctor or hospital to hospital. Bree members include doctors, nurses, hospitals, insurance companies, large companies that provide health care to their employees, and representatives from organizations dedicated to increasing health care quality.

Every year we choose three health care topics, bring together a group of clinical experts, and send recommendations on how to improve these topics to the Health Care Authority, which is the state agency in charge of public employee insurance and Medicaid. When we choose our topics we look to see if shared decision-making aids can help to make care better for patients, help patients get the type of care they need, and get the outcomes they want.

We have worked to improve care in:

• Addiction and Dependence Treatment
• Cardiovascular (heart) Health
• End-of-Life Care
• Hospital Readmissions
• Low Back Pain
• Maternity Care
• Spine Surgery
• Total Knee and Total Hip Replacement Surgery

Isn’t this already happening?

Unfortunately, sometimes when you go to see health care providers they may not talk about your health in a way that is easy to understand; they may not ask you what you want out of your health care. Sometimes people say that their doctor or health care team is not really listening to them and that the doctor and health team do not consider the type of goals a patient has for his or her own life. Across the country, surveys show that most doctors and health teams are not making medical decisions together with their patients using shared decision-making aids.[3] Patients are often not getting the type of care they prefer.

Your legislature and your state health care leaders also think shared decision-making is important. Washington State passed legislation in 2012 giving the Health Care Authority Medical Director the ability to certify shared decision making aids. This will be part of Healthier Washington and will help our health care community have access to high-quality tools. The Bree Collaborative has been involved in the first stages of this work and looks forward to these aids being available to our health care community in the topic areas we have identified as needing improvement. Our state hopes to first work on decision aids for maternity care, and then in total joint replacement (hip and knee) and spine surgery.

What can I do?

If you don’t understand something your doctor or medical care provider says, ask. You have the right to fully understand how treatment might help you or possibly hurt you. You have the right to be sure your health care team understands your goals and values. Read the recommendations made by our Collaborative, especially if you or a loved one is planning on having a health care service that we have addressed: www.breecollaborative.org/about/reports/. You are also welcome to attend any of our meetings and let us know what you think.  Information is listed here: www.breecollaborative.org/meetings/

Learn more about shared decision making, here: www.informedmedicaldecisions.org/what-is-shared-decision-making/

[1] Stacey D, Bennett CL, Barry MJ, Col NF, Eden KB, Holmes-Rovner M, Llewellyn-Thomas H, Lyddiatt A, Légaré F, Thomson R. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2011 Oct 5;(10):CD001431.

[2] Washington State Health Care Authority. Shared Decision Making. Accessed: May 2015. Available: http://www.hca.wa.gov/hta/Pages/shareddecisionmaking.aspx.

[3] Oshima Lee E, Emanuel EJ. Shared decision making to improve care and reduce costs. N Engl J Med. 2013 Jan 3;368(1):6-8.