Shared Decision Making
Shared Decision Making
The healthcare landscape has changed drastically over my 17-year medical career. Therapeutic options in skin disease, such as psoriasis and atopic dermatitis, have expanded and will continue to do so. Likewise, patient access to information via the internet, with varying degrees of validity, continues to grow exponentially. Healthcare providers today face unique challenges, many of which are not diagnostic in nature. Patient access to affordable medications, clinical-encounter satisfaction metrics, and the pressure for one to win trust and demonstrate knowledge that supersedes that of nonclinical websites or popular social-media “skin expert” influencers are just a few of the special challenges faced by healthcare professionals.
The growing portfolio of treatment options coupled with patients entering our clinics armed with information (that may or may not be correct) makes shared-decision making an integral part of the patient experience. Our commitment to providing quality care behooves us as providers to guide the discussion using evidence-based medicine and clinical experience, with respect to the patient’s values and preferences. Below is a very simplified approach to ensuring that patients are part of the decision-making process:
1. Discuss the diagnosis in simple terms.
2. Review treatment options with risks/benefits/potential adverse events. I will often ask, before diving into a discussion on something like Isotretinon or biologics, “Do you have any strong opinions on this treatment option?” Their answer can avoid unnecessary time on something they are not open to considering.
3. Acknowledge that you just shared a lot of information with them and ask, “What questions do you have for me?”
4. Once options are presented, pause again, and ask the patient about their desires and hesitations? Give them the option to go home and think about it. If they choose this route, caution about Google or social media for questions--encourage them to call YOU to discuss.
Patient-centered care is a core value shared across all medical specialties. Shared-decision making builds a trusting relationship between the healthcare provider and patients and ultimately leads to improved patient satisfaction. Patients are much more likely to be compliant if they have a stake in determining how to manage their condition.
On a broader scale, patients also have the right to participate in decisions about preventative care, like total-body skin exams. Within the dermatology clinic, we have an ethical obligation to offer this service to patients, but it is their choice to accept or decline. Preventative care opportunities outside of the clinic include providing community education or free skin cancer screenings, especially to reach patient populations who may otherwise not have access to dermatology care. An in-depth look at preventative care services in the primary care setting by the US Preventative Services Task Force in 2022 suggested that this approach could help address inequities in delivery of care.
Shared-decision making in preventative-care and ongoing management of dermatologic diseases provides a cornerstone to build a patient-provider relationship which is rooted in mutual respect and understanding. How are you engaging your patients in shared-decision making?
References
Barry, M. Collaboration and Shared Decision-Making Between Patients and Clinicians in Preventative Health Care Decisions and US Preventative Services Task Fource Recommentations. JAMA. 2022; 327(12):1171-1176. Doi:10.1001/jama.2022.3267
The SHARE Approach: A Model for Shared Decision Making-Fact Sheet. Content last reviewed September 2020. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/health-literacy/professional-training/shared-decision/tools/factsheet.html
Jennifer Conner, MPAS, PA-C resides near Indianapolis, IN where she practices at Dawes Fretzin Dermatology.