Overcoming shared decision-making challenges in healthcare involves integrating decision aids into electronic health records (EHR) and establishing fitting reimbursement models. The American Heart Association’s position paper highlights the need for improved reimbursement, accreditation, technology access, and training for healthcare providers to embed shared decision-making into clinical practice. While the approach fosters patient-centric communication, its limited prevalence demands concerted efforts to enhance implementation, emphasizing value-based reimbursement, team-based care, and patient resources. This strategy, bolstered by validated tools, serves to foster health equity and patient-provider collaboration.
Overcoming obstacles to shared decision-making in patient engagement requires innovative solutions such as the integration of decision aids into electronic health records (EHR) and the establishment of appropriate reimbursement models.
A recent position paper released by the American Heart Association (AHA) highlights the imperative to tackle the primary challenges associated with shared decision-making in patient-provider interactions.
The authors of the paper emphasize the need for healthcare providers to access enhanced reimbursement models, accreditation opportunities, shared decision-making technologies, and comprehensive training to seamlessly incorporate this strategy into clinical practice.
As healthcare shifts towards patient-centricity, shared decision-making emerges as a pivotal communication approach, replacing the traditional paternalistic model. This approach mandates healthcare providers to elucidate the patient’s existing medical condition, potential treatment alternatives, and the associated pros and cons. Subsequently, both patients and providers engage in a dialogue about treatment objectives and the potential impact of each option on these goals.
Through this collaborative process, patients and providers collaboratively design a treatment plan that aligns closely with the patient’s requirements.
Despite the considerable advantages of shared decision-making, the AHA authors underscore the limited prevalence of this practice. Shared decision-making occurs in merely about 10 percent of face-to-face patient encounters.
In their statement published in the AHA’s journal “Circulation,” the authors advocate for concerted efforts to integrate shared decision-making across all clinical practices.
This endeavor necessitates the establishment of robust measures to evaluate the value and effectiveness of shared decision-making, according to the authors. While current measures consider shared decision-making from both patient and clinician perspectives, there is room for improvement in evaluating content validity, interpretability, and the organizational factors influencing shared decision-making.
Furthermore, the report outlines key challenges hindering the implementation of shared decision-making, including:
1. Policies and reimbursement
2. Supportive leadership
3. Infrastructure with streamlined workflows
4. Clinician training
5. Access to decision aids
6. Patient engagement
To genuinely promote shared decision-making in patient engagement, the healthcare industry and individual healthcare organizations must confront these core challenges.
The authors suggest several strategic steps. Firstly, shared decision-making should be closely linked with value-based reimbursement models and facilitated through team-based care. Policies should also facilitate monitoring and evaluation of shared decision-making to guide quality improvement efforts. At the organizational level, the creation of accreditation and recognition models is pivotal.
Additionally, healthcare providers should incorporate shared decision-making into their digital workflows by incorporating decision aids, which are patient education tools, into the EHR. These tools should be supported by risk assessment scores.
In parallel, healthcare professionals require interpersonal training to effectively implement shared decision-making. Training should underscore the importance of team-based care and communication skills tailored to diverse patient populations.
Finally, there should be readily available resources for patients, including personalized communication, patient education materials, decision support, and trusted health-related messages in the media. For instance, public health messages about cancer screening can augment shared decision-making during clinical consultations.
Crucially, formalizing shared decision-making is vital for achieving health equity. Recognizing patients as active members of the care team and integrating their needs and viewpoints into treatment decisions fosters patient trust, as noted by the report authors.
Furthermore, validated tools for shared decision-making hold the potential to reduce implicit bias and contribute to improved equity in patient experiences. The authors propose that decision aids can minimize bias and standardize patient-clinician decision-making, ultimately enhancing clinical judgment.
Ultimately, enhancing patient-provider communication and shared decision-making enables healthcare providers to align with advancements in medical therapies. By placing shared decision-making at the core, patient care objectives are prioritized, ensuring that the myriad treatment options available are optimized to help patients attain their goals.
