Stronger Standards Needed for Shared Clinical Decision Making

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Clear definitions of shared decision making, as well as standardization and development of measures, need to be in place.
Clear definitions of shared decision making, as well as standardization and development of measures, need to be in place.

Policy makers and health systems need to strengthen standards guiding the practice of shared decision making, researchers urge. They say the practice promotes patient-centered care, shifts the burden of litigation to patients, and often reduces costs because patients tend to choose less expensive nonsurgical options.

"Clinicians who will be incentivized to use shared decision making may have misconceptions about what it is and skepticism of its value," Erica Spatz, MD, MHS, assistant professor in cardiology at Yale School of Medicine in New Haven and a researcher at the Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, Connecticut, and colleagues wrote in a viewpoint published in a recent issue of JAMA.1 "Well-defined standards are needed to help translate new policies into clinical practice without undue burden on clinicians."

Movement has been afoot in the implementation of shared decision making, the authors acknowledge. In 2007, Washington State incentivized shared decision making for elective procedures, and in 2016, it certified several decision aids for maternal-fetal care.

In addition, the National Quality Forum and the Centers for Medicare & Medicaid Services have both promoted the use of shared-decision making, with the former creating certification standards for shared decision aids and the latter making shared decision-making a precondition for payment for some conditions.

Nevertheless, "[e]ven as shared decision making expands, most clinicians and health centers outside the research setting have limited experience with decision aids, which may undermine the potential for shared decision making to engage patients in an open, transparent manner about health care choices," warn Dr Spatz and colleagues.

To ensure high-quality shared decision-making is practiced, the authors are calling for the creation of clear definitions of the practice, as well as standardization and development of measures.

"As defined by Washington State, shared decision making is a process undertaken between a clinician and a patient with a preference-sensitive condition...to help the patient decide among multiple acceptable health care choices in accordance with his or her preferences and values," they explain.

In contrast, they pointed to some instances in which institutions have informed patients of the appropriate clothing to wear for a procedure and considered that a shared decision-making process.

Dr Spatz and coinvestigators also stated that standardization of shared decision making helps to ensure quality, as well as identify institutions that excel or require improvements in this skill. Last, they say clinicians should receive training in the practice, and systems should be developed that integrate it into existing clinical workflows.

"Washington State, [the Centers for Medicare & Medicaid Services], and others have exercised their regulatory authority to implement shared decision making because of its potential to advance a more patient-centered, value-based health system and because of its potential to engage patients and reduce costs; these values are nonpartisan and are expected to be supported regardless of future health care reform," they concluded.

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References

  1. Spatz ES, Krumholz HM, Moulton BW. Prime time for shared decision making. JAMA. 2017;317(13): 1309-1310.
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