Reducing disparities in healthcare through shared decision-making

Engagement in healthcare is a key factor in determining health outcomes. People who actively participate in their healthcare tend to experience better health and live longer, while those who are passive recipients of healthcare often face poorer outcomes. Our work at Sprout Health Solutions aims to bridge this gap.

One of the most important methods our scientists use is shared decision-making, a collaborative process that ensures healthcare professionals (HCPs) and patients or caregivers can actively participate in treatment decisions. HCPs bring expertise in illness and treatment, while patients are the experts in their experience of illness, values and preferences. When successful, this process positively impacts patients’ satisfaction with treatment, adherence and quality of life.

Despite these potential benefits, a recent industry-sponsored study conducted by Sprout found that many patients do not feel involved in decisions about their treatment, do not know what questions to ask and leave appointments feeling that they lack information.

Our research showed that participation in healthcare is often linked to privilege – those with higher socioeconomic status, better education and access to resources are more likely to engage in shared decision-making. This means that people who are already disadvantaged may be further marginalised in healthcare, exacerbating disparities.

Exclusion from healthcare decisions can result from various barriers, including language, health literacy, cultural factors and systemic biases. To create a more equitable healthcare system, it is essential to actively involve all patients, regardless of background, in the decision-making process.

We also learned that a common barrier to shared decision-making among HCPs was a lack of time. In our experience, this process can be integrated into everyday healthcare interactions in a way that empowers all patients.

• Some HCPs believe that shared decision-making is only feasible with patients who are already engaged and knowledgeable about their health. However, activation is a dynamic process – patients can become engaged when provided with the right support, information and encouragement
• Shared decision-making can be an informal process where HCPs and patients/caregivers work together to consider the best course of action. When patients are involved in treatment decisions, they are more likely to start, take and persist with prescribed treatment
• Understanding the patients’ or caregivers’ values and preferences involves elicitation of any doubts and concerns about treatment. This should be integral to conversations about treatment because patients’ beliefs predict subsequent adherence, regardless of illnesses and treatments.

Shared decision-making relies on mutual respect and trust between patients and HCPs. The patients’ relationship with their healthcare team and the quality of communication between patients and HCPs are also key determinants of adherence.

• Interpersonal aspects of care that are important to patients include taking an interest in them, taking their concerns seriously, enabling them to feel comfortable discussing personal issues and providing information in a language they can easily understand, free of unfamiliar medical terms
• Those who need them should have access to translation services. Information should be available in the patient’s language, in audio or large print for those with visual impairment.

When patients feel heard, understood and supported, they are more likely to take an active role in their healthcare.

By prioritising engagement and inclusivity, shared decision-making can contribute to a more equitable healthcare system, where everyone can participate in decisions that impact their well-being. Bridging the gap in participation is not just beneficial for individual patients – it is a necessary step toward reducing healthcare disparities and ensuring better health outcomes for all.