Shared decision-making: 4 lessons learned

Physicians can learn some lessons in shared decision-making from the care one oncologist provided a patient with terminal metastatic cancer, writes Peter Ubel, M.D., a physician and behavioral scientist at Duke University, in a commentary in Forbes.

"Many doctors say they want to partner with patients in making healthcare choices, but most do not know how to accomplish this goal," says Ubel.

Rather than push a strong recommendation, physicians should provide patients the best available information with which to make those decisions themselves. Here's some advice based on the case of the unnamed oncologist:

Use the word "we," as in "So we need to think about what to do next." That was the case when the oncologist spoke to his patient who had stage 4 breast cancer, which had metastasized to her liver and bone, leaving her with substantial pain. In shared decision-making, both doctor and patient make medical decisions together, which his research shows is rarely achieved, Ubel says.

Don't overwhelm patients with information because they are likely to turn to the doctor and ask what course of action they should take. Instead, discuss the pros and cons of alternatives. The oncologist in this case focused on the big choice currently before his patient: whether she wanted to have chemotherapy to try and slow the spread of cancer. He explained the various options for chemotherapy.

Consider various factors to treatment, including costs to the patients. Once the patient decided she wanted chemotherapy, the oncologist talked about pros and cons of a pill versus intravenous treatment. He asked about her co-payments for brand name pills and whether that would be as affordable to her as infusion treatment.

Be realistic with patients. After discussing treatment alternatives, the oncologist reminded the patient that whatever treatment she chose, none was expected to cure her cancer. However, chemotherapy would give her a chance of slowing the cancer and allow her to live longer.

To learn more:
- read the commentary