Who is responsible for the outcome in shared decision making?

By | December 19, 2017
Shared decision making

Recently, there has been an increased focus on measures that not only drive towards better health outcomes, but also greater patient/person engagement. Within this realm, shared decision making has received enormous interest. Acting in the best interest of those we serve, physicians and providers must engage in conversations concerning shared goals and objectives. However, as we proceed to a more consumer-facing approach where the receiver of the care, the patient, begins to own greater responsibility in the decision making, are we shifting too much of the burden?

In our present healthcare ecosystem, there are numerous systemic problems. Some examples include lack of coordinated information that explains risks versus benefits in a way that is meaningful to the patient, relatively little pricing transparency, too few conversations regarding the degree of potential harm and side effects, or not discussing all the probable diagnosis and treatment options within a framework of likelihood and cost. By bringing the patient/person/consumer into the conversation when they have only partial information, are we at some level depending on them to be the arbiter within the framework of “shared decision” making?

In solving for this dilemma, the most inclusive and preferred method uses a multifaceted approach. Physicians and providers hold the responsibility of sharing their subject matter expertise within a more holistic context while simultaneously acknowledging the value in having the patient/consumer partake in the conversation more wholly. If we genuinely desire a working partnership, both parties have responsibilities and benefit from participating in the fuller conversation, which would elevate the likelihood of a positive outcome for all involved.

Hence, when done correctly, shared decision making will aid us in arriving at a better place in providing and delivering healthcare in the manner that encompasses the goals of both parties. However, in doing so, we need to remember that when those we serve are ill, requesting from them a shared decision is drastically different than holding a conversation with them in their times of sound health. Inquiring about what problems our patients are seeking to solve (to feel better, to reach the next Holiday, to avoid medication, etc.) and the contexts and nuances that shape their desired outcomes, will result in better solutions.

Consequently, during times that cohere, sharing personal knowledge, values, strengths, hopes, and definitions of success between the two parties will only improve the outcomes all are striving to achieve. Decisions, even if shared, that are agreed upon in a black box or with inadequate factual and contextual information will likely lead to sub-optimal results. Therefore, we need to work towards a model where shared decision making is done in a manner that enhances the value we are delivering. Since there are no black and white answers, we need to continue to dwell in the ambiguous gray. Let us apply shared decision making in a manner that enhances the desired outcome as defined by both the patient and the provider.