Shared decision making in realistic medicine: what works

Synthesis of recent evidence on the current use of shared decision-making in Scotland, and international evidence of what works in encouraging greater use of shared decision-making in clinical consultations.

Annex 3: Benefits of undertaking SDM

This appendix provides more information on the benefits of undertaking an SDM process.

Gives patients more information

This is made possible as SDM places the importance of a meaningful conversation at the centre of any interaction between healthcare professional and patient. These conversations are an important part of more active patient involvement (Walach & Loughlin, 2018; Coulter, 2006) which highlight a certain level of trust between patient and clinician (Fisher, et al., 2018; Gulbrandsen, et al., 2016). More active patients could lead to a more sustainable healthcare system (Coulter, 2006) as patients have less reliance on overburdened healthcare services. According to Coulter and Collins (2011), 'where support is offered, patients are more likely to succeed in making health-related changes and to self-manage more effectively', facilitated through meaningful conservations within SDM. This can reduce waste and variation by focusing on treatments and options with more beneficial outcomes (e.g. increasing the quality rather than quantity (at whatever cost) of life).

Focuses on treatments and options with more beneficial outcomes

SDM recognises that every patient may have different preferences in terms of what is important to them. For instance a ballet dancer may resist an aggressive steroid therapy to control asthma wheezing due to fear of muscle weakness and the clinician is not in a position to tell her the decision is wrong (they are her priorities) (Walach & Loughlin, 2018). The risks and benefits of treatments are particular to the patient and their prognosis (Jacobsen, et al., 2018). SDM encourages more beneficial patient outcomes, and reduce unwarranted waste and variation (created by overtreatment and preference misdiagnosis).

Reduces waste and variation

Enhancing a shared decision-making process this may encourage a focus on the treatments with more beneficial outcomes for the patient (Coulter, 2006). This could also lead to a reduction in unwarranted treatments, and thus waste. For Mulley et al (2012) this variation in unwarranted treatment and waste as formulated itself through 'the preference misdiagnosis'. Mulley et al (2012) termed this the silent misdiagnosis in which doctors automatically recommend a treatment that they are familiar with, irrespective of the patient preferences. SDM prevents the silent misdiagnosis by creating better informed patients with an understanding of the various treatment (or palliative) options and risks, and clinicians who have a better idea of the patient preferences. Thus clinicians are better placed to make a recommendation that is better for the patient in terms of their preferences whilst also reducing the unnecessary waste and variation of unwanted treatments. In addition SDM could save money through only carrying out treatments which are requested by fully informed patients (Mulley, et al., 2012). By measuring the instances of preference misdiagnosis the NHS will get a better handle on the costs associated with this, as well as an opportunity to measure SDM, and reduce waste and variation.



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