Shared decision-making is central in providing patient-centered care. Theoretical benefits of shared decision-making include patient empowerment and satisfaction, better treatment compliance and a stronger patient-doctor relationship. The potential downside of this approach includes patient anxiety and regret, should the decision lead to adverse outcomes. How important is the decision-making process in clinical practice?

What is shared decision-making?

Shared decision-making in healthcare is a collaborative process between the patient and the clinician, where sharing of information and expression of treatment preferences from both parties are done prior to reaching an agreed decision.

Factors influencing preferred role in decision-making

Patients’ preferred role in medical decision-making was found to be influenced by their perceived capability in participating in decision-making. In a sample of breast cancer patients, Brown et al.(1) found that after a consultation with the doctor where patients were able to obtain information about their condition, patients preferred a more active role in making treatment decisions. This suggests that patients who are better informed about their illness feel more empowered to take up a more active role. A good relationship with the healthcare provider has also been found to encourage patient participation in medical decision-making(2). Other studies have shown that trust in medical expertise and a lack of confidence in one’s medical knowledge encouraged preference for a passive role(3).

Do patients want to participate in decision-making?

Patients’ preference for participating in making treatment decisions varies from one individual to another. An individual’s preferred role in medical decision-making may change as his/her illness progresses(4). Some prefer surrendering control during the later stages of an illness and some prefer a more active role where there is severe disease progression.

How does decision-making influence patient satisfaction?

What is notable from the findings is that participation to the patient’s preferred level is the key factor to patient satisfaction, regardless of the role preferred(4). In situations where patients were compelled to make a decision or to surrender control, extreme dissatisfaction has been reported.

What can healthcare professionals learn from this?

There has yet to be a clear-cut answer on the impact of patients’ role in medical decision-making on health outcomes. What is known from research studies is that fulfillment of patients’ preferred level of participation is essential in patient satisfaction. It is therefore important for healthcare professionals to bear in mind that the decision-making process is an essential component of the doctor-patient relationship. Every patient’s preference for information and role in treatment decision is highly individualized and may evolve with time. The skill of framing clinical interactions that elicit and fulfill patients’ decisional role preferences sets the foundation of a good and trusting doctor-patient relationship. MIMS

Read more:
7 ways to build a productive doctor-patient relationship
Patient satisfaction vs. job responsibility: A nurse's call of duty
Doctor-Patient relationship in the era of social media

Sources:
1. Brown R, Butow P, Wilson-Genderson M, Bernhard J, Ribi K, Juraskova I. Meeting the Decision-Making Preferences of Patients With Breast Cancer in Oncology Consultations: Impact on Decision-Related Outcomes. Journal of Clinical Oncology. 2012;30(8):857-62.
2. Hofstede SN, van Bodegom-Vos L, Wentink MM, Vleggeert-Lankamp CL, Vlieland TP, Marang-van de Mheen PJ, DISC study group. Most important factors for the implementation of shared decision making in sciatica care: ranking among professionals and patients. PloS one. 2014 Apr 7;9(4):e94176.
3. Beaver K, Jones D, Susnerwala S, Craven O, Tomlinson M, Witham G, et al. Exploring the decision-making preferences of people with colorectal cancer. Health Expectations. 2005;8(2):103-13.
4. Gaston CM, Mitchell G. Information giving and decision-making in patients with advanced cancer: a systematic review. Social science & medicine (1982). 2005;61(10):2252-64.
5. Belanger E, Rodriguez C, Groleau D. Shared decision-making in palliative care: a systematic mixed studies review using narrative synthesis. Palliat Med. 2011;25(3):242-61
6. Beaver K, Jones D, Susnerwala S, Craven O, Tomlinson M, Witham G, et al. Exploring the decision-making preferences of people with colorectal cancer. Health Expectations. 2005;8(2):103-13.
7. Heyland DK, Tranmer J, O'Callaghan CJ, Gafni A. The seriously ill hospitalized patient: Preferred role in end-of-life decision making? Journal of Critical Care. 2003;18(1):3-10.