Shared decision making
Shared Decision Making (SDM) is a collaborative process in which doctors and patients work together to select tests, treatments and care management or support packages, based on clinical evidence and patients’ informed preferences and values. It explicitly acknowledges the fact that there is usually more than one way to treat a problem, including ‘no treatment’ and patients may require help to weigh up the benefits and harms of the options in order to determine the best choice for them.
There is good evidence that SDM benefits patients, improving the quality and appropriateness of clinical decision making. A Cochrane Review of 115 randomised control trials found that use of patient decision aids leads to improved knowledge and more accurate risk perceptions among patients, greater participation in decision-making, and more appropriate treatment decisions. This will include reduced demand for some screening procedures, such as PSA tests and surgical procedures, such as hysterectomies and knee replacement operations.
It is also an effective strategy for tackling overdiagnosis and overtreatment. For example, interventions to promote SDM, including SDM skills training, have been shown to lead to reductions in inappropriate antibiotic use in acute respiratory infections and better understanding of the risk of over-detection in breast screening.
A fundamental aim of Choosing Wisely is to use the shared decision making approach to reduce unnecessary tests and treatments. Therefore, many of the recommendations have links to decision aids, which will support you to have the necessary conversations with your patients.