Shared Decision Making, Contextualized

Robert L. Ferrer; James M. Gill

doi:10.1370/afm.1551

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Supporting shared decision making
Richard M. Hoffman

Published on: 01 August 2013

Published on: (1 August 2013)
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Supporting shared decision making
Richard M. Hoffman, Physician
With the recently published American Urological Association guideline on early detection of prostate cancer,(1) there is now consensus that no man should be screened for prostate cancer in the absence of shared decision making (SDM). However, the recent articles in the Annals of Family Medicine point out the challenges in accomplishing this goal. Han and colleagues present data from the nationally representative Nationa...
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With the recently published American Urological Association guideline on early detection of prostate cancer,(1) there is now consensus that no man should be screened for prostate cancer in the absence of shared decision making (SDM). However, the recent articles in the Annals of Family Medicine point out the challenges in accomplishing this goal. Han and colleagues present data from the nationally representative National Health Interview Study showing that SDM for prostate cancer screening occurs infrequently, particularly among men who do not get tested. The two reports on the randomized trial of educational interventions showed that targeting provider and patients only moderately improved measures of SDM.
What are the implications of these results for clinical practice? For one, the timing and format of decision support are probably quite important for enhancing SDM. A one-time physician exposure to a web-based curriculum might not be sufficiently durable. The American College of Physicians has produced a one-page summary of their recent guidance statement on prostate cancer screening that all physicians can access in real-time to guide discussions.(2) Additionally, rather than exposing patients to a computer-based program immediately before a clinic visit, physicians could present decision aids, which could be written, video, or web-based, well in advance of the visit so that patients can first review and discuss the material at home.
More importantly, even though SDM seems essential to the patient- centered care model, successful implementation requires a paradigm shift in the doctor-patient relationship. As the editorialists note, SDM should be incorporated into multiple health decisions that can occur during a patient's lifetime, enabling SDM to be perceived as a valued and expected component of high-quality medical care. Equally importantly, given the limited success in targeting practicing physicians to support SDM for a specific decision, physicians in training should be educated on the rationale and strategies for implementing SDM within the broad spectrum of patients facing preference-sensitive medical decisions.
References 1. Carter HB, Albertsen PC, Barry MJ, et al. Early Detection of Prostate Cancer: AUA Guideline. J Urol 2013;190(2):419-426. 2. Qaseem A, Barry MJ, Denberg TD, Owens DK, Shekelle P. Screening for prostate cancer: a guidance statement from the Clinical Guidelines Committee of the American College of Physicians. Ann Intern Med 2013;158(10):761-769.
Competing interests: I edit a prostate-cancer screening decision aid for the Informed Medical Decisions Foundation
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Competing Interests: None declared.