Shared Decision-Making & Patient Engagement

By Ginny Adams, RN, BSN, MPH, CPHRM, Senior Risk Consultant, Coverys

When it comes to providing the best care for our patients and generating better outcomes, one important thing we can do is evaluate our perception of the provider-patient relationship. Many clinicians were educated in an era with a prevailing mindset that the patient is the “subject” to be done unto by the clinician. Under that outdated model, patients were expected to comply with treatment plans, not contribute to the development of them. Certainly, we as clinicians meant well, but our style of caring was sometimes distant and too directive. In that era, the provider-patient relationship often lacked an emphasis on what we have come to appreciate as “shared decision-making” and meaningful “patient engagement.”

The good news is that the tide is turning. More clinicians are embracing the opportunity to improve patient outcomes and interpersonal relationships by rethinking the roles of patients, clinicians, and even patients’ family members. It starts with first recognizing that the partnership requires an invitation, and the invitation comes from the patient, not the clinician. We are not asking patients to partner with us. They are inviting us to partner with them. Providers are, in turn, asking to be let into the patient’s world in a very significant and sacred way. Truly engaging patients through this kind of honorable partnership requires a shift in thinking on the part of the practitioner. The culture of power and hierarchy has to go away. And with that shift, amazing things begin to happen.

In 2001, the Institutes of Medicine, in their groundbreaking publication, “Crossing the Quality Chasm,” defined patient- and family-centered care as being respectful of and responsive to individual patient preferences, needs, and values while ensuring patient values guide all clinical decisions. Patient engagement and patient- and family-centered care go hand-in-hand. It involves patients, families, representatives, and health professionals working in active partnership to ultimately improve health and healthcare. 

One simple example of how to make this shift is to change our thinking and our policies about who enters the examination room or even testing or procedure spaces. Unless there is a risk related to safety or infection, we must allow patients to bring family, friends, or other representatives with them when they come to us for treatment and advice. We must address the questions and comments of that broader sphere of influence, knowing that the people who accompany a patient are there to assist ― to help the patient get information and understanding, ask smart questions, and help the group arrive at treatment decisions that are in the best interests of the patient (not just medically, but also in alignment with lifestyles and values).

To deliver patient-centered care through meaningful patient engagement, we must develop models and processes for shared decision-making. Shared decision-making allows patients, their families, and their providers to make healthcare decisions together; taking into account clinical evidence, as well as the unique perspectives and values of the patient. Shared decision-making is always important, but particularly so when it comes to potentially life-altering decisions (like opting for cancer treatment or hysterectomy) and preference-sensitive tests and treatments (like advanced imaging for lung cancer).

As you are considering ways to improve shared decision-making in your own practice, remember that there are four hallmarks to truly engaging the patient in the process: respect and dignity, information sharing, participation, and collaboration. By centering your care on the patient through various levels of engagement and shared decision-making, you make it possible for many things to change for the better. 

Risks will be reduced as patients stay healthier, complying with the protocols you chose together. With preference-sensitive tests and treatments, patients who are truly engaged often choose options that are less expensive and invasive, reducing risk and keeping the costs of healthcare down. 

Even in the cases of adverse outcomes, there is evidence that a patient who believes you have truly listened and involved them in their care is significantly less likely to file a claim of liability, as they don’t blame you for decisions you made together. What’s more, engaged patients make more referrals and write great reviews, contributing to the growth of your business. And, in the end, you just might find that you love your job more when the emphasis is on working with the patients, and not just on them.

No legal or medical advice intended. This post includes general risk management guidelines. Such materials are for informational purposes only and may not reflect the most current legal or medical developments. These informational materials are not intended, and must not be taken, as legal or medical advice on any particular set of facts or circumstances. 

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