Advancing Shared Decision Making
The Informed Medical Decisions Foundation, now a division of Healthwise, has been working to advance evidence-based shared decision making since 1989. We believe the only way to ensure that high quality health care decisions are being made is for a fully informed patient to participate in a shared decision making process with their clinician. Through our research and advocacy efforts, we are dedicated to helping people make better health decisions.
Today’s guest blogger is Dawn Stacey, RN, PhD, CON(C). She holds a research chair in Knowledge Translation to Patients and is a full professor in the School of Nursing at the University of Ottawa. She is a scientist at the Ottawa Hospital Research Institute where she is director of the Patient Decision Aids Research Group. She is the principal investigator for the Cochrane Review of Patient Decision Aids, co-chair of the Steering Committee for the International Patient Decision Aid Standards Collaboration (IPDAS), and co-investigator for the Cochrane Review of Interventions to Improve the Adoption of Shared Decision Making.
I first heard about shared decision making when I was applying for my master’s degree in 1998. Annette O’Connor, often considered the “mother” of shared decision making (SDM), was my thesis supervisor for my master’s and my doctoral studies.
Nurses are well-positioned on the team to be able to make decisions with patients and to support the patient to engage in shared decision making with other health care professionals. Interestingly though, shared decision making is not taught within basic training programs in nursing.
The big question is how do nurses fit?
Natalie Joseph Williams conducted a systematic review in 2014 to describe patient-identified barriers of facilitators to shared decision making. Patients said that nurses should explain the information, provide support by listening to patient preferences, and then provide doctors with the patient’s preferences because the patients are too frustrated with doctors not listening to them. Patients really felt that nurses could actually be the facilitators in shared decision making.
In reviews of conceptual models of shared decision making, the focus was on the patient and physician only. Then France Légaré and I, with an interprofessional and international team, created the interprofessional shared-decision-making model. This model explicitly discusses the involvement of two or more health care professionals working together with the patient and his or her family. Within this model, we also talk about a decision-coaching role, which could be taken on by a member of the health care team such as a nurse, social worker, or psychologist. This role fits with what the patients in Natalie Joseph Williams’ paper said, because the decision coach is able to help the patients understand the information and clarify their preferences. And the decision coach could then also communicate or advocate for the patient.
What I’ve heard from non-nurse researchers around the world is that they suddenly realized nurses are really important when it comes to implementing shared decision making. Nurses are critical members of the health care team and are a key for successful implementation of SDM.
Over the last 20 years, nurses have been important members of the scientific community advancing shared decision making in clinical practice. Nurses have been instrumental in establishing the International Shared Decision Making conferences, creating conceptual models to inform development of decision support interventions, developing effective interventions such as patient decision aids and decision coaching, and establishing instruments to measure processes and outcomes of shared decision making.
Today’s guest blogger is David Arterburn, MD, MPH. He is an associate investigator at the Group Health Research Institute in Seattle and an internal medicine physician at Group Health. He has served as medical editor for the Informed Medical Decisions Foundation, now a division of Healthwise, for many years.
At Group Health, we are creating a culture of expectation that no preference-sensitive medical decision is made in the face of insufficient knowledge among patients about their options and that patients’ preferences are aligned with their treatment decisions. Continue reading
Today’s guest blogger is Leslie Kelly Hall. She is senior vice president of policy at Healthwise. Leslie guides policy efforts for health information technology, standards, interoperability, privacy, and security that will help people engage in their health.
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When I was 40 years old, I was diagnosed with an aggressive breast cancer that required immediate surgery and chemotherapy. When I heard the biopsy was positive, my first thought was, “I’ve been in training for this all my life.” Continue reading
“I’m sorry to tell you this, but you have an early-stage breast cancer.”
So began the conversation I had with many patients following a biopsy of a suspicious area found on a screening mammogram. Before coming to Healthwise, I was a cancer nurse navigator. I am also a breast cancer survivor. I have had this conversation from both sides of the phone call. It is a fine example of how nurses can, and should, be involved in shared decision making. Continue reading