Health care leaders have to clearly see the value proposition of shared decision making, which primarily is insuring that well-informed patients are making decisions that are clearly aligned with their stated goals and preferences. There is ample evidence from randomized trials that patient decision aids can help support the shared decision making process. Health care leaders can support their care providers and teams by developing standard work flow processes that integrate patient decision aids as well as knowledge and preference assessment into routine clinical care; and by establishing metrics to track the distribution of decision aids and the occurrence of shared decision making conversations. Health care leaders – from both payer and provider organizations – must drive this change; however, engaging large employers in conversations about the value proposition for shared decision making may help this work move forward more rapidly.
Health technology assessment (HTA) involves values and judgements, but there have been few attempts to seek the views of members of the public or to ensure that they have access to the results. Patients and citizens can make an important contribution to HTA by determining priorities for assessment, designing and conducting assessments and appraisals, receiving and using the findings, and engaging in debates about policy priorities and rationing. Those responsible for HTA should make greater efforts to involve the public and ensure that the findings are accessible to patients for use when making treatment choices.
What patients and the public expect from doctors is changing. It has always been expected that medical education will teach clinical knowledge and practical skills, as well as school students and trainees in a professional culture that emphasises their responsibility to be trustworthy and act in the interest of their patients. In recent years however, many people have come to expect more. Nowadays patients expect clinicians to respect autonomy, to listen to them, to inform them, to take account of their preferences, to involve them in treatment decisions and to support their efforts in self-care.