Informed Healthcare Decisions: The Role of Conversations

In a post last month, I discussed an article by Bataldan et al. onco-designing health care. I agreed with the article’s authors that we might learn something if we look at health care through the lens of co-design.

A short Viewpoint piece in the April 2014 issue of Health Affairs has a relevant message. (10.1377/hlthaff.2015.1354 Health Aff April 2016 vol. 35 no. 4, 627-629).

Four Mayo Clinic researchers reflect on 10 years of work on shared decision making, which involves providers and patients working together to decide on a course of care. Shared decision making sounds great and seems like at least part of what it will take to meaningfully co-design health care.

The authors say that they, along with most designers of shared decision making, started with the idea that shared decision making consisted of a two-step process: clinicians should summarize the best evidence on options and then have the patients choose among those options.

It turns out the two-step process doesn’t seem to work to help patients actually figure out what to do to advance their treatment and care. The Mayo researchers now believe that conversation between the patient and clinician provides the key to effective decision making:

“Our group has come to understand that the challenge of evidence isn’t simply communicating what we know clearly to our patients—although that alone is a significant challenge. Instead the real challenge is how to use the evidence to discover what’s best for the particular patient in light of his or her circumstances and values. The medium in which this happens is patient-clinician conversation.”

“…conversation in shared decision making….[is] an instrument of care appropriate to the uncertainties of illness and treatment. Shared decision making is called for in situations in which the best option is not clear. These situations threaten the health of the patient, the expertise of the clinician, and the management of response. They are emotional in nature.” (p. 628)

Can you establish, improve and maintain a system that promotes shared-decision making as described by the Mayo researchers?

I think this question indicates a planning and design problem. For that kind of problem, I’ve argued that the Model for Improvement provides a core method (here).

Clarification of aims of care for the patient, definition of measures to know if treatment choices result in experiences closer to desired aims, and ideas for treatment choices and actions, linked to appropriate testing cycles look like a great way to structure a series of conversations in effective shared-decision making.