Doctors ‘lag behind’ shared health decision making

A clinical focus article, published recently in the Medical Journal of Australia, argued that a new approach to healthcare called “shared decision making” could have benefits such as improving patients’ knowledge, communication between doctors and patients, and in some cases, reducing the inappropriate overuse of tests and treatments.

According to the paper’s lead author, Associate Professor Tammy Hoffmann, from the Centre for Research in Evidence-Based Practice (CREBP) at Bond University, shared decision making is more than just good communication between patients and doctors.

“Even before getting to the step of making a decision, it involves helping patients be aware of all the options, and the benefits and harms of each option,” Dr Hoffmann said.

“Shared decision making helps both patients and doctors to talk through all the relevant information and decide together the best option.”

The article explained that for most decisions, there is usually not one option that is clearly the best for each patient.

“Each patient has their own circumstances and preferences that will influence what decision is best for them. A decision that is best for one patient isn’t necessarily best for another,” she said.

“For example, the decision to be screened for prostate cancer is confusing for many men and their families. Both options – being screened or not being screened – have benefits and harms, and different people will weigh up these benefits and harms differently.

“A key aspect of shared decision making is for patients to be aware of all options – including the option of ‘doing nothing’ – which is sometimes the best option.”

The paper argues there are misconceptions about the shared decision making process that are hampering its implementation in Australia. The most frequently reported was that shared decision making would lengthen the duration of each consultation.

Other misconceptions cited were: that patients would be unsupported when making health care decisions; not every patient wants to share in the process; most people are not able to participate; it cannot be used by vulnerable people; clinicians already do it; and engaging patients will increase their anxiety.

Professor Chris Del Mar, from Bond University, who is also an author on the paper, said a common example of shared decision making would be a child with a middle ear infection.

“Antibiotics are no longer regarded as necessary for middle ear infections, as they once were. Except in exceptional circumstances, middle ear infection gets better without treatment,” Dr Del Mar said.

“Antibiotics do provide a slight benefit – a slightly shorter illness of a few hours on average – but they also provide some harm, such as increasing the chance of getting thrush or diarrhoea,” he said.

“Most importantly, shared decision making provides an opportunity for doctors and patients to talk together about the evidence, before deciding on a treatment.”

The article highlights that many countries have implemented programs or policies to help shared decision making become a more routine part of healthcare consultations, but that there have been no such nationwide initiatives in Australia.

“Australia is drastically lagging behind many other countries in all aspects of shared decision making – policies, lobbying, advocacy, research funding, training, resources and implementation,” Dr Hoffmann said.

“In the absence of a coordinated national effort, we encourage individual clinicians to begin incorporating shared decision making into their consultations with patients when a health decision is needed.

“Australia’s health training and delivery organisations urgently need to begin prioritising and planning to make shared decision making a reality in Australia.”