Shared Decision Making
PCORI Answers Critical Questions
Evidence gaps can make it difficult to know which decision aids and shared decision making methods are most effective. PCORI funds studies answering questions about which tools and approaches can be most effective at helping patients and clinicians come to treatment decisions, such as:
Clinician: Working in an emergency department, I see a lot of people brought in with chest pain, but not all really need a hospital stay. What is the best way of sharing evidence to help them make informed decisions about their care?
Counselor: I run a program for people trying to quit smoking. Is there something that would be more effective than informational brochures to help my clients decide whether lung cancer screening is right for them?
Patient: I don’t like taking painkillers every day for my lower back pain, but I worry that surgery would keep me out of work for a long time. How can I let my doctor know what’s important to me, so we can reach the treatment decision that will work best for me?
The Significance of Shared Decision Making
There is seldom a one-size-fits-all healthcare choice that works well for every person. Shared decision making helps people and their healthcare providers communicate better. It encourages patients to more actively participate in their care decisions, increasing the chance that they will follow through and be satisfied with the outcomes.
Study Results that Support Better-Informed Decisions
Head CT scans may detect evidence of brain injury in children after minor head trauma, but they also expose children to radiation. This study found that a decision aid used in emergency departments helped parents make better-informed decisions about whether their children would receive CT scans. Parents who used the aid had a better understanding of the symptoms of concussion, their child’s relative risk of brain injury, and the pros and cons of head CT scans.
Although chest pain sends many people to emergency departments, a significant percentage are not having a heart attack or other serious heart problem. Evidence from this study showed the benefits of patients and doctors using a shared decision making tool to guide next steps.
Shared Decision Making Study Spotlights
PCORI-funded studies provide evidence that can help support shared decision making. This study helps patients and their clinicians choose among the many available treatments for prostate cancer.
This study looks to understand how best to help parents of young children with sickle cell disease (SCD) and their clinicians make a treatment decision around hydroxyurea. Hydroxyurea is a medication recommended for very young children with SCD, but many parents have concerns about its safety and long-term side effects that if not addressed can disproportionally inform their decision.
Most people want to be involved in decisions about their health care, including which tests they’ll get, which medicines they’ll take, and which procedures they’ll undergo. Shared decision making tools can help address many of the questions patients may have.
New Projects to Implement Shared Decision Making
|In June 2018, PCORI’s Board of Governors approved $8.4 million to fund the first four projects to result from our initiative to support implementation of effective shared decision making (SDM) approaches in practice settings. Two of the projects, in Alabama and Colorado, will implement SDM strategies formally tested and demonstrated to be effective in studies we funded. The other two, in California and New Hampshire, will incorporate new evidence from studies we funded into existing and tested SDM strategies and then implement the updated strategies.|