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.
Every other year, members of the shared-decision-making community gather in a different hub of the world to discuss the evolution of patients and providers engaging in a collaborative conversation around health care decisions. This July, the gathering was quite the landmark event as shared decision making and evidence-based practice united at the first joint International Shared Decision-Making/International Society for Evidence-Based Health Care (ISDM/ISEHC) Conference in Sydney, Australia. Over 300 people from around the globe met at the University of Sydney July 19–22 to share knowledge and inspire action to improve the entire care experience.
Three of our very own attended and also presented during the event: Ben Moulton, senior vice president of the Foundation; Richard Wexler, chief clinical integration officer; and Carrie Levin, research director. We spoke with them about highlights of the meeting.
- From an advocacy and policy perspective, many in attendance are looking at the policy implications of SDM. One particular area of focus is around informed consent, which is gaining importance as a lever for broad use of SDM. Too often the informed-consent process is based on a signed form rather than a collaborative conversation around the best available evidence and the patient’s informed preferences. The evolution of informed consent is beginning, and the new standard should document that shared decision making has occurred.
- Attendees agree that SDM is the right thing to do, but the question of how to incentivize SDM was a discussion among a special interest group. In the end, the feeling was that aligned incentives are necessary to maximize SDM. And it’s important to note that incentives don’t always need to be monetary. Looking ahead, we need to study the various circumstances and incentivize accordingly.
- Family engagement in the decision-making process is gaining more traction and leading the way for a triad (patient/family/care team) instead of a dyad (patient/care team). Many discussions in Sydney focused on how to involve family members in decisions about their loved one’s health care. We’ve talked long enough about why we need family engagement, and now we need to move beyond it being a great idea and make it a reality.
- Training of medical students was the subject of a number of presentations throughout the 4-day event. The competition for spots in medical school curriculum is quite high, and unfortunately communication skills generally don’t make the cut. Training of SDM skills has struggled to find a spot in the past, but it may be more effectively paired with evidence-based practice than communication. Asynchronous learning is one approach, and we’ve developed an online course for providers that helps them strengthen their communication skills so conversations are built around evidence-based practice and patient preferences. Researchers at Dartmouth are also exploring this type of learning program.
Check out #ISDMISEHC for reflections from other attendees about this landmark event.
By: Michael J. Barry, MD and Patty Skolnik Editor’s note: The following exchange is a conversation between Patty Skolnik and Michael Barry regarding the current controversy about physicians’ maintenance of their licensure and certification. Patty Skolnik is the founder and … Continue reading
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