If researchers find the tool does improve shared decision making, they hope to work with health technology and electronic medical systems to get the system embedded in the electronic medical system. Patients could access the surveys prior to their visits and then have the surveys included as part of their permanent medical records.
“As you talk about patient-provider communication and shared decision making, it is two parties that are at play,” notes Dr. Cozad.
Barriers: Physician Attitudes
Data from patient surveys indicate a gap often exists between physicians’ and patients’ perceptions of how much shared decision making is taking place. Although many providers report they engage in shared decision-making practices, patients may not share this perspective.6 Thus, decisions may not be as truly shared as physicians often believe.
Dr. Desai believes that shifting physicians’ attitudes is another key component to increase shared decision making. Clinicians who have conducted their visits a certain way over many years may be unlikely to change unless they see a problem.
“If people feel they understand what their options are and feel like you have made a decision together, they are more likely to be adherent, but they are also more likely to achieve their target. It’s all connected to overall having better improvement in the quality of care,” says Dr. Desai. She adds, “Most rheumatologists would see the value in trying to get all of their patients into remission or low disease activity if that’s an appropriate goal for that patient. I think that if we frame it that the shared decision making is a means to that end, … people are more likely to get on board.”
Practicalities
Assessing levels of shared decision making and integrating quality improvement methods are challenges in a research setting as well. As part of a research grant, Dr. Desai’s group is assessing shared decision making in rheumatoid arthritis in the context of physicians’ patient notes. However, she says this may not be a very reliable way to assess how much shared decision making is really happening, because physicians are not expected to document every aspect of the clinical encounter. Patient surveys are another avenue to investigate patients’ perceptions of shared decision making.13
Dr. Desai recommends that clinicians working in a group setting set aside time together to compare notes about how they handle patient education and shared decision making. Her team is also reinitiating a focus group of rheumatoid arthritis patients who can provide feedback on patient desires and shared communication. They also use an existing patient support group to ask patients about their preferences for educational materials to help guide shared decision making.
