The goal of shared decision-making is to help patients make informed health
decisions. A mismatch between the treatment the patient receives and the treat- ment the patient prefers (due to a lack of discussion of the patient’s concerns and goals or the patient’s not being fully informed about their options) is called a preference misdiagnosis.15 Shared decision-making is used primarily for making major decisions, such as decisions about cancer treatment, whether or not to have a screening, or whether to have surgery. However, it is also appropriate for managing chronic conditions, as it has been shown to improve both adherence to medications in patients with chronic conditions and patient engagement and diabetes prevention outcomes.16,17
Patient Decision Aids
Patient decision aids are structured tools that help facilitate shared decision- making. Although not essential to the process, in a systematic review including more than 31,000 patients, they have been shown to improve medical decisions, increase patient involvement, and increase the alignment of preferences and treatment.18 A patient decision aid can be an easy-to-read document, a video, an interactive website, or a visual aid that incorporates the evidence-based, unbiased information about the patient’s condition and treatment options along with the risks and bene- fits of each option as they apply to each patient. High-quality decision aids present information in a neutral way, offering information to patients and supporting them in making the decision that best aligns with their individual needs but not pushing them toward a particular decision.19
Currently, there are no national certifications
for patient decision aids and no specific aids for the condition of obesity. However, examples of patient decision aids are available for use as templates for creating aids for chronic care management.20-22 When using a patient decision aid, the health care professional summarizes all
the key options as well as the corresponding research, allows the patient time to read and think about these options, and assesses how each option relates to what is important to the patient. There is an important distinction between patient decision aids and educational
materials that are not patient decision aids. A decision aid supports a patient in making a decision by fully exploring all of their relevant options, whereas non-aid educational materials typically provide detailed information about a single possible approach.19
Steps in Shared Decision-Making
Several implementation models for the shared decision-making process exist; however, they all contain similar core steps. The following model, described in more detail in Box 5.2, is taken from the Agency for Healthcare Research and Quality. It includes five steps for health care practitioners to follow and goes by the acronym SHARE.23,24
1. Seek your patient’s participation: Invite the patient to participate and communicate that a choice exists.
2. Help your patient explore and compare treatment options: Present the options, including the option to do nothing. Use evidence-based resources to compare the treatment options. Present the patient decision aid, if available.
3. Assess your patient’s values and preferences: Stop and listen to what mat- ters most to the patient.
4. Reach a decision with your patient: Guide the patient to express whether any of the presented options is consistent with what matters to them most
70 SECTION 1: Foundations of Treatment: The Human Element
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