The Oregonian, Wednesday, June 24, 2009
The toughest medical decisions have no single best answer -- it depends on what's important to the individual. Shared decision making has emerged as the optimal way for helping patients work through the maze of options.
It's a collaboration in which the doctor and patient exchange medical information and information about the patient's values, check each other's understanding, and reach a consensus about the course most consistent with the patient's beliefs and preferences.
"However shared decision making is defined, most studies show that most physicians participate very little in it," said Janice Hanson, a researcher at Uniformed Services University in Bethesda, Md., in a commentary in the Archives of Internal Medicine. In one recent study that analyzed discussions about end-of-life care, only one in 50 talks met all of the researchers' criteria for shared decision making. Doctors, for instance, rarely checked whether families understood information they'd been given.
Many hurdles stand in the way, said Dr. Elizabeth Steiner, an associate professor of family medicine at Oregon Health & Science University.
• Patient's health knowledge. "Even people who are well educated in other arenas are not necessarily health literate," Steiner said. Weighing treatment options often requires knowledge of biology and the ability-to grasp statistical probabilities, such as the odds of success and risk of side effects.
• Doctor's communication skills. "Health professionals have to be able to speak a language other than doctor,' " Steiner said.
• Medical evidence. Clinical trials don't always make clear what treatment is likely to work best for a given patient, and often the evidence is in flux, with new reports conflicting with prior findings.
• Limited time with patients. Shared decision making requires a trusting relationship that can't be built in one or two 15-minute encounters.
• Engaged patients. "We can educate patients, cajole and coax all we want, but if patients aren't prepared to make the effort, then it's not going to happen," Steiner said.
- JoeRojas-Burke, medical research and science