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Tuesday

 

When a Patient Becomes a Partner in Her Care






















Nurse Stephanie Buxhoeveden appreciated that her doctor took a team approach to treating her multiple sclerosis.

Stephanie Buxhoeveden was a 25-year-old nurse and graduate student when she was diagnosed with multiple sclerosis three years ago. “Even though I'm a healthcare provider myself, it took a while to make decisions,” she recalls. With her doctor’s support, Buxhoeveden became actively engaged in all decisions about her treatment. “I appreciated that my doctor took a team approach,” she says. “It really gives you a sense of control.”

For patients like Buxhoeveden, a driving force in their treatment is a principal known as shared decision making (SDM). “Shared decision making is about increasing patient knowledge and participation in their own care,” says Sanjai Sinha, MD, assistant professor of medicine and director of the care management program at Weill Cornell Medical College.

The Informed Medical Decisions Foundation describes shared decision making as “a collaborative process that allows patients and their providers to make healthcare decisions together, taking into account the best scientific evidence available, as well as the patient’s values and preferences.” Decisions such as weighing the benefits and risks of statins to prevent heart disease, or choosing between surgery and radiation therapy for cancer, are made collaboratively based on what matters most to the patient.

A traditional healthcare model assumes that there are certain clear, logical measures that patients and their doctors have to take, says R. Sean Morrison, MD, co-director of the Patty and Jay Baker National Palliative Care Center and professor of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai. “In reality ... a lot more goes into it,” Dr. Morrison adds, such as quality-of-life issues.

Shared decision making “requires clinicians to leverage their knowledge with the ability to empathetically communicate with a patient,” says Michael R. Gionfriddo, PharmD, of the Mayo Clinic Shared Decision Making National Resource Center. “The best way to help patients is to arm them with knowledge about their medical conditions, elicit and respect their values and preferences as they pertain to these conditions, and motivate them to make the best choices possible,” Dr. Sinha says.

In Buxhoeveden’s case, she had to make some tough decisions about what drugs to take. “Every medication has side effects,” she says. Choosing one over the other is about “what you can put up with or tolerate, and what are the benefits and risks of each.”

Challenges for Patients and Doctors
While shared decision making is gaining momentum, its collaborative approach poses challenges for patients and their health teams.

One of the key challenges for healthcare providers is to understand their patients’ needs in the decision-making process, according to Morrison. “Most people want to be involved,” he says, but not always in the same way. “Some [patients] want the details; others just want the big picture.”

As the Mayo Clinic’s Gionfriddo puts it, “Shared decision making requires meaningful conversations about how treatment options fit with a person’s values and life context, and concludes in an agreement that a specific course of action makes sense for this patient.” But, he adds, “the communication skills required are not as emphasized in medical training as the clinical knowledge, and therefore many clinicians don't have as much experience with, or comfort with, the type of communication required for shared decision making."

Similarly, patients may be reluctant to be part of the decision-making process, even though research suggests that limited patient involvement increases the likelihood for poorer outcomes. “Some patients feel the responsibility of making decisions is too onerous. It’s too much work or burden,” says Glyn Elwyn, MD, a professor at the Dartmouth Institute for Health Policy and Clinical Practice in Hanover, New Hampshire.

“I think a good clinician can handle this by asking, ‘How does this fit into your life?’ Even if the clinician makes the decision, it’s still informed by the patient’s view,” Dr. Elwyn says. “It’s not about giving patients sole responsibility. I don’t recommend that.”

For the patient, “knowledge is power,” says Kathleen Costello, vice president of healthcare access advocacy, services, and research at the National Multiple Sclerosis Society. “When you’re informed, you can be more confident in approaching your doctor.”

Benefits of Decision Aids
Helping patients become better informed about their health and treatment options are tools known as decision aids, which combine printed materials, video demonstrations, and risk calculators. “Decision aids, now abundant online, are useful to help patients feel confident in the decisions they make,” Sinha says.

A provision of the Affordable Care Act (ACA), under Section 3506, calls for establishing a program to develop, test and disseminate certificated patient decision aids. According to a report in the British Medical Journal (BMJ), over 500 decision aids have been developed to date. Many are available on websites such as Mayo’s Shared Decision Making National Resource Center, the Dartmouth-Hitchcock Center for Shared Decision Making, and the Agency for Healthcare Research and Quality.

Research, including a 2013 report in the The New England Journal of Medicine, suggests that patients who use decision aids tend to “choose less invasive surgical options and more conservative treatment.” That has helped reduce surgery rates and costs for some procedures, such as hip and knee replacements.

“These tools are important when people are asked to contemplate any healthcare decisions,” Costello says. “Most people want to be involved. It’s their life, it’s their care. The decision will have a direct effect on their life.”

Buxhoeveden, who now works with MS patients at Neurology Associates of Fredericksburg in Virginia, agrees. “The most important thing you can do ... is to take charge,” she says. “You know what’s best for you. You know how things are going to affect your life. Take a team approach, and shared decision making comes naturally. Realize your doctor is your partner.”

Story Source: The above story is based on materials provided by EVERYDAYHEALTH
Note: Materials may be edited for content and length

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