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How Healthcare Can Overcome Shared Decision-Making Challenges

Integrating decision aids into the EHR and creating reimbursement models will be key to clearing shared decision-making hurdles.

A new position paper from the American Heart Association (AHA) is calling to address key challenges to shared decision-making in patient engagement.

Particularly, the paper authors said healthcare providers need better reimbursement models, access to accreditation, shared decision-making technologies, and training to integrate the strategy into clinical practice.

Shared decision-making is a key patient-provider communication strategy rising in prominence as healthcare moves away from paternalism to patient-centricity. The technique requires healthcare providers to describe a patient’s current disease state, potential treatment options, and the costs and benefits of each. From there, patients and providers can discuss patient treatment goals and how each treatment option could affect those goals.

In doing this, patients and providers work together in teams to create the treatment plan that best adheres to patient needs.

But despite the many benefits to shared decision-making, the AHA authors said that the practice is not commonplace. In fact, AHA said shared decision-making takes place in only around 10 percent of in-person patient encounters.

In the statement published in the AHA’s journal Circulation, the authors called for more concerted efforts to implement shared decision-making in all clinical practice.

This foremost begins with leaning on adequate shared decision-making measures, which the team said are key to assessing the value and efficacy of the strategy.

Current measures look at shared decision-making from both the patient and the clinician perspective, but there’s room for growth in assessing content validity, interpretability, and the organizational factors affecting shared decision-making.

The report also outlined some of the leading challenges to practicing shared decision-making, including

  • Policies and reimbursement
  • Supportive leadership
  • Infrastructure with efficient workflows
  • Clinician training
  • Access to decision aids
  • Patient engagement

In order to truly fulfill efforts to increase shared decision-making in patient engagement, the healthcare industry and individual organizations will need to zero in on the primary challenges getting in the way of shared decision-making.

For one thing, shared decision-making needs to be connected to value-based reimbursement models and facilitated through team-based care, the report authors recommended. These policies should also support shared decision-making monitoring and evaluation to guide quality improvement. And at the organizational leadership level, creating accreditation and recognition models will be key.

What’s more, healthcare providers need mechanisms to integrate shared decision-making into their digital workflows. Adopting decision aids, the patient education tools used to support shared decision-making, into the EHR will be a crucial first step. These tools should be supported by risk scores.

And in addition to the health IT tools, providers also need interpersonal training to practice shared decision-making. Training should emphasize team-based care and skills for communicating with diverse patient populations.

Finally, there need to be patient-facing resources available. That includes patient education materials, personalized communication, support for decisions, and complementary health messaging in the media from trusted figures. For example, public health messaging about cancer screening can enhance shared decision-making in the clinic.

Importantly, formalizing shared decision-making will be crucial as healthcare works to achieve health equity. Acknowledging the patient as a member of the care team and considering patient needs and perspectives in care decisions will help to build patient trust, the report authors said.

They also noted that the validated tools for shared decision-making will help support better equity of patient experience.

“Decision aids may help to remove implicit or unconscious bias, which contributes to health disparities, from the clinical encounter,” the report authors wrote. “Introducing structure and standardization into patient-clinician decision-making with decision aids may enhance clinical decision-making.”

Ultimately, practicing better patient-provider communication and shared decision-making will help healthcare providers keep pace with therapeutic advancements. Shared decision-making centers patient care goals and ensures that the many treatment options available will help patients achieve those goals.

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