For shared decision-making, information beats recommendations

By Matt Kuhrt

The healthcare industry has increasingly become aware of the value of shared decision-making in effective patient care. As doctors help to educate patients and walk them through their available options, the information imbalance they seek to correct can lead to unintended consequences, writes Terri Fried, M.D., in the New England Journal of Medicine.

If all options were approximately equal and everybody had access to exactly the same information, there wouldn't be a problem. In reality, all options aren't equal, and doctors are typically better aware of this fact than patients. Moreover, doctors are more likely to make a strong recommendation in cases where they see one or more options as superior to others. Conversely, doctors are less likely to give a strong recommendation where the optimal clinical path is more difficult to discern.

This approach makes some sense if we care only about outcomes, but a process by which the most difficult decisions to make get ceded to the party with the lesser information, experience and capability to make them can't fairly be called shared.

Even as a general proposition, decision-making is notoriously difficult. "When the physician makes a strong recommendation at the expense of letting the patient know what other options are available, the physician is not doing what the patient wants," Fried points out in a follow-up interview with MedicalXpress.

In order to find the right balance, she suggests clinicians work to mitigate their tendency to push a strong recommendation in favor of providing patients the best available information with which to make those decisions themselves. As a further benefit, this helps to ensure the decision that does get made balances all of the patient's priorities, which may not happen as often as physicians think it does.

To learn more:
- read the article in the NEJM
- check out the interview in MedicalXpress

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