Shared decision-making for patients
What competencies and prerequisites do patients require?
The implementation of SDM presupposes a specific procedure and concrete steps in the physician-patient communication. In this respect, the central focus lies on a specific discussion behaviour on the part of the physician. But demands are also placed on the patients.
In order to play a part in the process of shared decision-making, patients not only need to perceive and understand their health problems but should also be able and willing to recognise and communicate their own feelings, attitudes and expectations regarding the illness as well as the advantages and disadvantages of the available treatment options.
Moreover, it is necessary for patients to absorb detailed information, evaluate it on an individual basis and weigh the treatment options against each other together with their physician. Only then can decisions be made in a patient-oriented manner.
How can patients be supported in decision-making?
It is often difficult to make a decision, particularly when the concern is with a serious illness or a possible chronic burden. In this respect, it can be helpful for patients to be aware of the options, and to know which benefits and risks the various options hold.
One way of supporting patients in this process is represented by so-called decision aids. These prepare people to participate in medical decisions. Decision aids can take the form of brochures, but also of videos or websites. They describe the options open to the patient and also take into account the personal importance of the advantages and disadvantages of different treatment paths.
In this way, patients are prepared for shared decision-making, and in the discussion with the physician can act as experts for their own life circumstances and preferences.
Decision aids are implemented in particular when there are several options which are all medically justifiable and are comparable in empirical terms. If none of the options has a clear medical advantage over the others, it is especially important that the personal values of the benefits and risks constitutes the deciding factor.
The Canadian work group of Annette O’Conner conducted a meta-analysis of the effectiveness of decision aids and discovered that decision aids increase the participation of patients. Their use increases the likelihood of making informed, value-oriented decisions. For example, the number of operations that take place at the patients’ own discretion is reduced through the use of decision aids, without any deterioration of the patients’ state of health or satisfaction. (O'Connor AM, Bennett CL, Stacey D et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2009 Jul 8;(3):CD001431.)
Decision aids are implemented in the English-speaking countries. In Germany, several attempts have been made to translate American decision aids into German. A high level of interest was found among those surveyed, as well as a positive attitude towards decision aids. However, it was apparent that cultural differences were too high. (Albrecht K, Simon D, Buchholz A et al. How does a German audience appraise an American decision aid on early stage breast cancer? Patient Educ Couns. 2011 Apr;83(1):58-63.)
A database of relevant German and English decision aids can be found here.