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Explore This IssueFebruary 2018
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SAN DIEGO—At the ACR/ARHP 2017 Annual Meeting Nov. 3–8, a session on how to promote shared decision making with patients highlighted the role of the multidisciplinary professional team. And perhaps just as importantly, it noted the importance of providers recognizing their own implicit biases, which can get in the way of shared decision making.
Presenters from the Hospital for Special Surgery’s Department of Social Work Programs in New York City described a process of collaboration that allows patients and providers to make treatment decisions together as a dance, taking into account both best clinical evidence and patients’ values and preferences. “But sometimes patients are doing a different dance than we are,” said Jillian Rose, LCSW, assistant director for Community Engagement, Diversity and Research at the hospital.
“Look at the waltz of shared decision making as an opportunity for intervention. Start where the patient is. How can our patients play a greater role in their care?”
To better involve the patient, Ms. Rose suggested shifting the focus from, “What’s the matter with you?” to “What matters to you?” That kind of decision making can lead to better patient outcomes, including better understanding of their condition, reduced anxiety, increased satisfaction with treatment decisions and greater willingness to undergo treatment.
Other steps to promote shared decision making include presenting options to patients, using decision aids, providing information on both benefits and risks, and helping patients evaluate options based on their goals and concerns. In other words, incorporate the patient’s perspectives into the conversation.
“With the move toward more patient autonomy and the explosion of technology, patients are having conversations about their healthcare decisions on social media, with Facebook friends, on Twitter chats and with peers. If we don’t involve the patient [in the conversation], we’ll be left out of providing invaluable information to our patients that can influence their care and lead to better outcomes,” Ms. Rose said.
Barriers to shared decision making include lack of time for busy clinicians, perceived threats to the power relationship between doctor and patient, lack of communication, lack of trust and patient characteristics that can lead providers to form conclusions that get in the way of collaboration.
The time we think we are saving by not soliciting and including the patient perspective will be lost if our decision making lacks patient buy-in. This can lead to non-adherence to the treatment plan; patients can be lost to follow-up, sometimes ending up in emergency departments with worse outcomes. “The first step in achieving shared decision making with patients is checking our own biases to ensure we are not unconsciously making recommendations based on our agenda, values and stereotypes,” Ms. Rose said.
Your Implicit Bias
The concept of implicit bias posits that we all have attitudes we aren’t consciously aware of, which can affect our understanding, actions and decisions in an unconscious manner. Such bias impacts the quality of the clinical interview, diagnostic decision making, treatment recommendations and referrals to specialty care. Other core issues impacting patient participation in decision-making discussions include race, culture and ethnicity, perceived power differentials between patient and clinician, and lack of empathy or receptivity by the provider.