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Problem-based shared decision making: The role of canonical SDM steps.

Victor M Montori1, Merel M Ruissen1,2,3, Megan E Branda1,4

  • 1Knowledge and Evaluation Research Unit, Mayo Clinic Rochester, Rochester, Minnesota, USA.

Health Expectations : an International Journal of Public Participation in Health Care and Health Policy
|November 30, 2022
PubMed
Summary

Shared decision-making (SDM) steps are rarely followed in their intended order during clinical encounters, even with interventions. This study found that providing information and stating preferences were common, but the full SDM process was infrequently observed.

Keywords:
SDMproblem-basedpurposefulshared decision makingsteps

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Area of Science:

  • Health Services Research
  • Clinical Practice Improvement
  • Patient-Centered Care

Background:

  • Shared decision-making (SDM) is a collaborative process involving patients and clinicians to make healthcare choices.
  • The canonical steps of SDM are intended to ensure informed and patient-centered decisions.
  • Understanding the real-world application of SDM is crucial for improving healthcare quality.

Purpose of the Study:

  • To assess the frequency and adherence to canonical steps of shared decision-making (SDM) in primary care encounters.
  • To examine how different forms of SDM relate to the occurrence of its core steps.
  • To evaluate the impact of an SDM intervention on the observed SDM process.

Main Methods:

  • Analysis of 100 video-recorded primary care encounters from patients with type 2 diabetes.
  • Independent coding of encounters to identify SDM instances and classify them into four problem-based forms.
  • Documentation of the occurrence and timing of four canonical SDM steps: choice awareness, information provision, preference stating, and decision-making.

Main Results:

  • A total of 485 SDM steps were observed (mean 4.85 per encounter), with information provision and preference stating being most frequent.
  • The prescribed order of SDM steps was followed in only 16% of encounters.
  • SDM step frequency varied by SDM form, but no distinct patterns emerged across forms.
  • An SDM intervention did not significantly alter the distribution of SDM steps compared to usual care.

Conclusions:

  • The canonical steps of shared decision-making are infrequently implemented in their prescribed order in clinical practice.
  • Current SDM interventions may not effectively promote the complete and sequential application of SDM steps.
  • Further research is needed to optimize SDM processes and enhance patient involvement in healthcare decisions.