Commonwealth Fund Research on Shared Decision Making Tools

When patients are given decision aids, such as educational booklets, DVDs, or interactive tools, to help them make treatment choices, they are more knowledgeable and satisfied with their care. But the use of such aids as part of "shared decision making"—a communication approach that seeks to balance clinicians' expertise with patients' preferences—has until recently been limited to research trials. Now some health systems and public policymakers are supporting more widespread use of shared decision making in efforts to promote patient engagement, reduce inappropriate use, and control costs.

The latest issue of Quality Matters from the Commonwealth Fund examines a recent national IOM survey of adults facing a medical decision—to take a new medication, have elective surgery, or undergo a cancer screening—in which patients overwhelmingly said they wanted to learn about the risks associated with various treatment options and have their providers listen to them. But less than half of patients reported that their provider asked them about their goals and concerns for treatment.

To address this problem, some private payers and public policymakers, as well as some health care systems, are encouraging the practice of shared decision making, which involves not just a physician recommending a course of action, or a patient left on their own to make a choice, but rather both parties working together to balance clinicians' experience and expertise with patients' preferences and values. Decision aids such as educational literature, videos, or Web-based tools are designed to help patients prepare for these conversations by weighing the potential benefits, risks, and uncertainties of a medical procedure.

As we work to implement more value-based purchasing strategies, shared decision making can play an important role in changing the physician-patient relationship to work toward providing more patient-centered care.