Integrating shared decision-making in patient engagement plans

In recent years, there has been a noticeable trend in people taking greater control of their own health, with one survey highlighting that half of the respondents reported being proactive about their well-being. Meanwhile, the global market for home diagnostics is expected to grow by 4.5% in the next seven years, underlining the increasing autonomy people are seeking in managing their health.

While there has been a recently increased interest from the public, individuals with chronic conditions have been actively managing and overseeing their health and well-being for decades. However, care satisfaction among these groups can vary, and some patients feel that substantial improvements to their overall quality of life are hard to come by, resigning themselves to the familiar level of care they have always known.

Research shows that patients who are proactively involved in decisions about their own treatment and disease management are both more satisfied and achieve a better overall quality of life.

Shared decision-making allows patients to take an active role in decisions about their care. It happens when patients – sometimes aided by families and friends – and their healthcare providers (HCPs), work together to select tests, treatments, management or support programmes based on their needs, values and preferences. In traditional, often outdated healthcare models, doctors, who are often deemed the experts, made treatment decisions with patients having a passive role. In contrast, shared decision-making shifts the dynamic to give patients a voice and fosters a collaborative dynamic, putting patients at the centre of healthcare decisions.

Shared decision-making was popularised in the 1980s, but interest has increased in traditional and social media in the past five years. Shared decision-making is now a key component of treatment according to the ‘Council of Europe: Guide to health literacy’ and has been added to clinical practice guidelines in various countries, including the US, UK, France, Germany, Netherlands and Spain. Alongside practices that traditionally incorporate patient preferences in care decisions (eg, oncology, HIV and palliative care), it’s now recommended that shared decision-making is implemented in a number of different chronic conditions.

Through shared decision-making, patients gain a better understanding of their condition by actively participating in decisions about their care. This leads to better outcomes, increases compliance with their treatment and improves satisfaction with their care. In turn, shared decision-making can: help doctors to better understand the patient experience; identify gaps in patient care; create a more personalised plan for each patient to address their unique and holistic needs, and potentially reduce health disparities in disadvantaged patient populations by promoting equitable care, increasing overall doctor satisfaction in the quality of care provided.

In theory, shared decision-making is what modern healthcare systems should be striving for, but in practice, implementation of shared decision-making has proven quite difficult. While doctors are familiar with shared decision-making, many find it difficult to pinpoint if, and when, they received formal training on it. Doctors are often constrained by appointment length and may also lack the practical tools to involve patients directly in treatment decisions. On the other hand, patients may be hesitant to assume a more active role in consultations with their doctor and may need more practical skills and confidence to articulate their needs clearly.

Implementation of shared decision-making initiatives and activities requires proper planning and often starts with ensuring that doctors and patients ‘speak the same language’.

A successful plan should consider addressing the following aspects:

• Perception: leading the discussion on the existing perception of care within a specific disease therapy area with both patients and doctors (eg, ranging from a paternalistic approach to co-operative discussion)
• Education: simplifying awareness by providing accessible but comprehensive information about the benefits of shared decision-making and the patient experience to all parties involved
• Communication: creating tools and techniques to aid communication between HCPs and patients during the consultations and build a long-standing rapport.