Most patients want more info for shared decision making

Last week, FiercePracticeManagement reported on a study of low-income Californians that revealed patients were more willing to become more involved in their healthcare, if only they were able to receive more information from their doctors to help them make decisions. A nationwide study published in the Journal of the American Medical Association shows that this view may be more representative of patients as a whole.

In particular, the study of 1,068 adults conducted by Consumer Reports National Research Center for the Institute of Medicine's Evidence Communication Innovation Collaborative found that 90 percent of surveyed patients said they wanted their doctors to offer them options--not just their best recommendation--for making a medical decision, but far fewer people were actually offered this information by their doctors. In addition, two-thirds of patients agreed they wanted to know the risks of each option, including how a choice might affect their quality of life. Nearly half agreed that they wanted to discuss the option of doing nothing.

However, patients' experiences rarely matched up to their desires. According to the study:

  • 61 percent strongly agreed that their provider listens to them
  • Half strongly agreed that their provider explains the risks of their options
  • 36 percent strongly agreed that their provider clearly explains the latest medical evidence
  • 47 percent said that their provider takes into account their goals and concerns
  • 37 percent said that their provider explains the option of not pursuing a test or treatment

"This gap represents an enormous missed opportunity," William D. Novelli, a Georgetown University professor and former AARP CEO, and colleagues wrote. "Healthcare practitioners have a key role to play in bridging this gap by routinely offering all the reasonable options for healthcare decisions through systematic implementation of unbiased, evidence-based tools, such as decision aids," they continued.

Contrary to a more paternalistic way of thinking, physician expertise is merely one of three elements required for high-quality decision making, the researchers said in an Institute of Medicine discussion paper. "The answer to any given medical question is patient-specific; it depends upon the medical evidence, the providers' clinical expertise, and the unique and individual preferences of the patient and family," they wrote.

To learn more:
- see the abstract from the Journal of the American Medical Association
- see the discussion paper from the Institute of Medicine
- read the article from UPI