How to integrate shared decision-making into your practice

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doi:doi: 10.12788/jfp.0536

Applied Evidence

How to integrate shared decision-making into your practice

J Fam Pract. 2023 January;72(1):7-17 | doi: 10.12788/jfp.0536

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References

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Effort to provide relevant, evidence-based information. The clinician provides treatment options applicable to the patient, including the risks and benefits of each (potentially using one of the decision aids in the following section), to facilitate a values-based discussion and decision.

Patient support and assistance. The clinician assists the patient in navigating next steps based on the treatment decision and arranges necessary follow-up.

Various case studies and examples of SDM conversations have been published.^15-17,24 Video examples of optimal²⁵ and less than optimal²⁶SDM conversations are available on the Massachusetts General Hospital Health Decision Sciences Center website (https://mghdecisionsciences.org/) under the section “Tools & Training >> Videos about Shared Decision-Making.”²⁷

SDM and motivational interviewing: Both can serve you well

SDM and motivational interviewing share many common elements,²⁸ and it’s useful to take advantage of both techniques. Preference-sensitive care situations may require a combination of approaches.

Overall uptake of shared decision-making practices remains low, even in situations such as lung cancer screening, in which SDM is a requirement for reimbursement.

For example, motivational interviewing may be a beneficial tool when dealing with a patient who is initially against colon cancer screening (evidence clearly favors screening in some form over no screening) and has a history of avoiding medical care. Through an SDM approach, motivational interviewing may identify an opportunity to prioritize the patient’s preference to minimize medical intervention by ensuring that the patient is familiar with noninvasive colon cancer screening options. After sufficiently eliciting a patient value aligned with screening and engaging the patient’s own motivations for follow-through, a more thorough SDM conversation can then help clarify the best options.

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