Dr. Armstrong is an assistant professor of neurology at the University of Florida (Gainesville, FL, USA) and Director of the Mangurian Clinical-Research Center for Lewy Body and Parkinson’s Disease Dementia. She also serves as an evidence-based medicine methodology consultant for the American Academy of Neurology’s clinical practice guideline program. She currently has a career development grant from the Agency for Healthcare Research and Quality (AHRQ) to investigate the impact of patient, caregiver, and advocate engagement on clinical practice guideline question development. Her research focuses on mechanisms and outcomes of patient engagement in guidelines, patient and family engagement in clinical decision-making, and patient-centered outcomes in Lewy body dementia.
What You’re Not Telling Your Doctor
Shared decision making is the term used to describe the approach in healthcare where patients and physicians partner to make a medical decision by considering the patient’s values and goals alongside the best medical evidence.
In order to do shared decision making, physicians must know their patients’ values and goals. Values might include continuing to live independently at home, managing a bothersome symptom without medication side effects impacting work or school, or avoiding medications. Values can be general approaches to life or can reflect someone’s judgement on the pros and cons of a specific situation. Values can also relate to a specific moment in time, such as wanting better symptom control for a wedding.
Knowing a patient’s values helps physicians provide high quality medical care and gives a context for decisions. Shared decision making itself involves multiple steps. First, identify the decision to be made. Second, discuss the medical evidence for the different options. What is the chance that a treatment will help? What are the risks? What are the costs? Third, explore how the patient’s values and goals interact with the different options. Finally, make the decision.
Research shows that shared decision making results in improved medical knowledge and understanding, higher patient satisfaction, and greater trust between patients and physicians. Decision aids – tools that guide patients and physicians through the shared decision making process – increase knowledge, lower patients’ internal conflict when making a decision, and get patients more engaged in the decision-making process.