Shared Decision Making
The Significance of Shared Decision Making
Most people want to be involved in decisions about their health care. But patients, their families, and their clinicians don’t always know the best ways to discuss topics such as the possible trade-offs in choosing treatments or patients’ personal preferences.
Shared decision making addresses these concerns. In shared decision making, patients and clinicians discuss diagnostic or treatment options, including their effectiveness and their potential benefits and harms, in ways that are designed to be easier for patients to understand. Patients are prompted to think about and communicate their preferences regarding treatment outcomes and other issues of importance to them. Clinicians and patients then decide on the care plan that makes the most sense given the patients’ preferences.
Research has found that shared decision making can increase patients’ satisfaction, result in changes to the care they receive, and improve their health outcomes.
Topic Spotlight
PCORI has funded 55 comparative clinical effectiveness research studies related to shared decision making. (As of February 2022)
PCORI has awarded $128 million in funding for comparative clinical effectiveness research studies related to shared decision making. (As of February 2022)
PCORI has funded seven implementation projects that seek to integrate effective shared decision making approaches in healthcare settings and help patients and their clinicians make choices that are best for them. (As of February 2022)
Research Study Results that Support Better-Informed Decisions
For Many, Antibiotics Treat Appendicitis as Well as Surgery in the Short Term
The PCORI-funded CODA Study found that using antibiotics to treat appendicitis worked as well as surgical removal of the appendix for most patients in the three months post-treatment, as reported in the New England Journal of Medicine. Health outcomes were similar for each treatment group. More than 70 percent of patients on antibiotics avoided having surgery and missed less time away from work or school, but nearly 30 percent ultimately needed to have their appendix removed.
Five-Year Outcomes for Common Bariatric Surgeries
The PCORnet® Bariatric Study, which is studying outcomes among patients who undergo common weight-loss surgeries has published several papers in prominent medical journals. One JAMA Surgery article compared diabetes remission outcomes among patients who underwent gastric bypass and gastric sleeve surgeries. Another JAMA Surgery article detailed five-year outcomes, finding that patients who had gastric bypass were significantly more likely than those who had gastric sleeve to end up back in the hospital in the years following surgery.
Tool Reduces Decision Conflict Over Kids’ CT Scans
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.
Shared Decision Making Research Study Spotlights
Engaging Parents and Providers of Children with Sickle Cell Disease
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.
Making Treatment Choices with Shared Decision Making
Candid discussions occurring early in a patient's diagnosis are paramount. A pair of caregivers say that such conversations and decision aids, such as pamphlets and videos, can play an important role in helping patients and their families make realistic treatment choices. They also share their perspectives as stakeholders on the PCORI-funded DECIDE-LVAD trial and a Dissemination and Implementation project.
Related PCORI Funding Announcements (PFAs)
2019 PCORI Annual Meeting
The 2019 meeting included a plenary session on the uptake of research results in real-world clinical practice settings, and a breakout session with examples of shared decision making and how shared decision making includes evaluation of options based on care goals, concerns, and personal context of individual.