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NEW ORLEANS — Integrating shared decision making into treatment decisions positions patients and healthcare providers as partners in the care relationship with a goal of improving both patient satisfaction and clinical outcomes. Strategies for the implementation of this treatment model were discussed by Dawn Velligan, PhD, Henry B. Diehlmann Chair of the Department of Psychiatry at the University of Texas Health Sciences Center in San Antonio, in her presentation at the 2017 Psych Congress.
Shared decision making is a collaborative and dynamic process that recognizes patients both as individuals and as equal partners in their care. With the use of reflective listening and sharing of options and choices, patients are empowered to be active participants in their treatment.
Patients receiving care for mental illness often report an imbalance in their interactions with their care providers. Dr Velligan described the results of a focus group in which patients described not feeling respected or valued. They often did not understand treatments and wanted more information and choice on options. Strategies to address these concerns can result in deeper patient engagement, improved follow through with treatment recommendations, and improved outcomes. A shared decision making approach is particularly valuable in elucidating patient preferences to guide decisions when there is no clear best approach to treatment.
Numerous support tools are available to assist in the decision making process. The Controlled Preferences Scale informs clinicians on how involved patients prefer to be in their treatment decisions. The Elwyn Shared Decision Making model outlines provider behavioral strategies to encourage patient involvement in treatment choice, options, and decisions. “Patients also have responsibilities,” Dr Velligan advised. In describing the Tell-Ask-Choose-Review (TAC-Review) program at her institution, Dr Velligan describes how patients are instructed on what their role is and how to get the most from their visits, resulting in more positive engagement.
Provider barriers to effective shared decision making include lack of knowledge on specific medications or comfort with their use, as well as perceived risk associated with treatment. Provider biases also include misinformation about treatment adherence, longstanding habits, and communication style. Patient biases include cognitive impairment and low numeracy.
Dr Velligan provided concrete suggestions for providers to encourage shared decision making, such as inviting patients to participate, prompting patients for information on their values and preferences, encouraging patient choice, and ensuring that the communication of risk associated with treatment is framed in a balanced manner. “Ask your patients how much they want to know,” Dr Velligan advised, “so that they can tell you what they are comfortable with.”
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Velligan DI. The truth about shared decision making. Presentation at: Psych Congress; September 16-19, 2017; New Orleans, LA.