Sharing decisions with patients: is the information good enough?

TLDR

Shared decision making, which involves patients and clinicians jointly making and owning decisions, is increasingly valued for incorporating patient preferences, yet patients often lack sufficient information and clinicians frequently underestimate patients’ desire for and ability to process information, limiting the effectiveness of such involvement. The authors aim to evaluate the hypothesis that shared decision making improves clinical outcomes, with ongoing trials providing optimism. The proposed solution is to provide patients with written or audiovisual materials that enable them to inform themselves and engage in discussions with health professionals. Evidence shows that patients who adopt an active role in hypertension, breast cancer, and diabetes management experience better outcomes, while treatment that ignores patient values can be inappropriate.

Abstract

Editorial by Richards and Coulter Shared decision making, in which patients and health professionals join in both the process of decision making and ownership of the decision made, is attracting considerable interest as a means by which patients' preferences can be incorporated into clinical decisions.1 When there are several treatment options which may have different effects on the patient's quality of life, there is a strong case for offering patients choice. Their active involvement in decision making may increase the effectiveness of the treatment. Trials are currently under way to test this hypothesis formally, but there are good grounds for optimism. Patients with hypertension benefit if they are allowed to adopt an active rather than a passive role in treatment, 2 3 patients with breast cancer suffer less depression and anxiety if they are treated by doctors who adopt a participative consultation style,4 and patients who are more actively involved in discussions about the management of their diabetes achieve better blood sugar control.5 Patients whose doctors are ignorant of their values and preferences may receive treatment that is inappropriate to their needs.6–8 Patients cannot express informed preferences unless they are given sufficient and appropriate information, including detailed explanations about their condition and the likely outcomes with and without treatment. Yet many report considerable difficulties in obtaining relevant information.9 There are various reasons for this. Health professionals frequently underestimate patients' desire for and ability to cope with information. Consultation times are limited—there is often insufficient time to explain fully the condition and the treatment choices. Health professionals may themselves lack knowledge of treatment options and their effects. A solution to this problem is to ensure that patients have access to written or audiovisual material, to inform themselves and to use in discussion with health …