Shared decision-making has become an instrumental part of the transition to value-based healthcare, as research shows that patients, providers, and healthcare systems can benefit from increased knowledge, improved patient satisfaction, reduced costs, and more accurate risk perceptions.
In fact, the Agency for Healthcare Research and Quality (AHRQ) provides clinicians with a simple but useful approach to shared decision making that includes the use of evidence-based medicine to compare the benefits and risks for each course of treatment. The SHARE approach incorporates the use of meaningful discussion to determine the most optimal treatment decisions for the patient.
Step 1: Seek the patient’s involvement
- Invite patients to be involved in their healthcare decisions.
- Review the health issue and inform the patient of all of their options.
- Ask the patient take part in decision making and include family or caregivers in discussions.
- Remind the patient that their involvement is necessary.
Step 2: Help the patient explore and compare treatment options
It is common for a patient to have several treatment options, including the option to forgo treatment. When there is not a clearly superior option, use evidence-based resources to compare the treatment options.
- Review and assess what the patient understands about their options.
- Make a list of the available options and have a meaningful discussion using common terminology.
- Discuss the risks, benefits, and limitations of each option.
- Clearly communicate any numbers and use simple visual aids to help the patient visualize and comprehend more effectively.
- Offer evidence-based decision aid tools if available.
- Summarize by reviewing the options again.
- Use the teach-back method to confirm understanding. Ask the patient to explain in their own words what has been discussed.
Step 3: Assess the patient's values and preferences
- Encourage the patient to discuss what is most important to them. It might be: Recovery time. Up-front costs. Pain Management. Returning back to normal activities.
- Use open-ended questions.
- Listen actively while showing empathy.
- Acknowledge the values and preferences that matter to the patient.
Step 4: Reach a collective decision
- Encourage the patient to consider what is most important to them in determining the right course of treatment.
- Help the patient move to a decision by asking if they are ready to make a decision.
- Ask if the patient needs more information or educational materials to assist in making the decision.
- See if the patient may need additional time to consider the options.
- Confirm the decision with the patient.
- Schedule follow up appointments for the treatment and any additional consultations necessary
Step 5: Evaluate the patient's decision
- Monitor the degree to which the treatment decision is implemented.
- Assist the patient with managing barriers to implementing their decision.
- Revisit the decision with the patient and determine if further decisions need to be made.
- Support the patient to ensure the decision has a positive impact on health outcomes.
- Many decisions can and should be revisited after a trial period.