How Rheumatologists Can Integrate Shared Decision Making into Clinical Practice

CHICAGO—Shared decision making plays a critical role in getting patients involved in their own care and improving the clinical outcomes of their disease. In an ACR Convergence 2025 session, titled Enhancing Shared Decision Making in Rheumatic Disease Management, Jennifer L. Barton, MD, professor of medicine at Oregon Health & Science University; Mrinalini Dey, MBBChir, clinical PhD fellow in rheumatology and internal medicine at King’s College London; and Karine Toupin-April, PhD, an associate professor at the School of Rehabilitation Sciences at the University of Ottawa, provided attendees with key information needed to integrate SDM in clinical practice. Along with defining the principles and importance of shared decision making in managing patients with rheumatic diseases, the experts identified barriers to implementing it as well as tools and resources to facilitate its implementation. They discussed the need to develop actionable plans and illustrated ways to incorporate shared decision making in clinical practice through case studies.

Overview

Dr. Barton led the session by first acknowledging the many definitions of shared decision making and sharing one developed by the Agency for Healthcare Research and Quality (AHRQ) that she feels describes it well:

“Shared decision making is a collaborative process in which patients and clinicians work together to make healthcare decisions informed by evidence, the care team’s knowledge and experience, and the patient’s values, goals, preferences and circumstances.”

She emphasized key steps in shared decision making that include first defining the problem, then creating a choice awareness for the patient, discussing treatment options in detail, discussing what matters most to the patient and finally discussing the patient’s values and preferences to decide the best course of action.

Presenting data from a scoping review of 63 studies in rheumatology, Dr. Barton emphasized that the data show shared decision making improves outcomes in rheumatic diseases by improving patient satisfaction with their treatment decisions, improving self-efficacy in the healthcare setting, improving patient-client trust and improving adherence to chosen treatment plans.¹

However, she also pointed out that rheumatologists often do not engage in shared decision making. For example, in a study she conducted, 30% of adults with RA report poor communication around decision making with their clinicians, and factors independently associated with poorer communication include older patients, those with limited English proficiency, people with limited health literacy and those with a lower trust in their physician.²

Research shows low literacy tools like this RA card increase knowledge, decrease decision conflict, and improve disease activity. (Click to enlarge.)