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Why & How to Pursue Shared Decision Making with Your Patients

Ruth Jessen Hickman, MD  |  Issue: June 2018  |  June 21, 2018

Another aspect of shared decision making is realizing when a treatment change is needed. For example, Dr. Desai’s group is now collecting patients’ scores on RAPID3 (Routine Assessment of Patient Index Data 3) via tablet computers in the waiting room to measure rheumatoid arthritis disease activity. The RAPID3 score is automatically uploaded into the medical record and can be used during the office visit to show patients how their rheumatoid arthritis is responding to treatment over time. This can aid patients and providers to make shared decisions over medication changes.

“I think medicine has evolved to where you really want the patient to be an equal partner in the decision making around medications,” Dr. Desai concludes. Unfortunately, practicalities, such as time, continue to pose barriers to implementing shared decision making in many clinical settings. But increased awareness and willingness on the part of physicians to embrace shared decision making is likely to help. More patients may want to participate in shared decision making than providers realize—they just need the encouragement and guidance to do so.

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Ruth Jessen Hickman, MD, is a graduate of the Indiana University School of Medicine. She is a freelance medical and science writer living in Bloomington, Ind.

References

  1. President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Making Health Care Decisions. The Ethical and Legal Implications of Informed Consent in the Patient–Practitioner Relationship. Washington D.C.: 1982.
  2. Eddy DM. Designing a practice policy: standards, guidelines, and options. JAMA. 1990 Jun 13;263(22):3077–3084.
  3. Barry MJ, Edgman-Levitan S. Shared decision making—pinnacle of patient-centered care. N Engl J Med. 2012 Mar 1;366(9):780–781.
  4. Singh JA, Saag KG, Bridges SL Jr, et al. 2015 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Rheumatol. 2016 Jan;68(1):1–26.
  5. Smolen JS, Landewé R, Breedveld FC, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis. 2013 Mar;73(3):492–509.
  6. Elwyn G, Frosch D, Thomson R, et al. Shared decision making: A model for clinical practice. J Gen Intern Med. 2012 Oct;27(10):1361–1367.
  7. World Health Organization. Adherence to long-term therapies: Evidence for Action. Geneva, Switzerland: World Health Organization; 2003.
  8. van den Bemt BJ, Zwikker HE, van den Ende CH. Medication adherence in patients with rheumatoid arthritis: A critical appraisal of the existing literature. Expert Rev Clin Immunol. 2012 May;8(4):337–351.
  9. Alten R, Krüger K, Rellecke J, et al. Examining patient preferences in the treatment of rheumatoid arthritis using a discrete-choice approach. Patient Prefer Adherence. 2016 Nov 1;10:2217–2228.
  10. O’Malley AS, Carrier ER, Docteur E, et al. Policy options to encourage patient phyisian shared decision making. National Institute for Health Care Reform. 2011;5:1-10.
  11. Joseph-Williams N, Edwards A, Elwyn G. Power imbalance prevents shared decision making. BMJ. 2014 May 14;348:g3178.
  12. Stacey D, Légaré F, Col NF, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2014 Jan 28;(1):CD001431.
  13. Doherr H, Christalle E, Kriston L, et al. Use of the 9-item Shared Decision Making Questionnaire (SDM-Q-9 and SDM-Q-Doc) in intervention studies—A systematic review. PLoS One. 2017;12(3):e0173904.

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Filed under:Patient Perspective Tagged with:patient-centered carephysician patient relationshipshared decision making

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