Measuring the impact of Shared Decision Making in the consultation room

Published on May 11, 2023 – Clients who are well prepared before meeting with their health practitioners are better able to identify and articulate their treatment goals and options. This is one of the conclusions from a recent scientific publication on Shared Decision Making. 

Ruth Pel-Littel wrote her dissertation, supervised by -among others- Julia van Weert (ACHC), in 2021, on the value of using the Shared Decision Making model for older people with complex care issues. Shared Decision Making is an intervention where the care recipient and practitioner make treatment decisions together rather than the physician alone. With Shared Decision Making, older people feel more confident about the choices they make, are more motivated to stick with treatment, and are also less likely to choose treatments that do not contribute to their quality of life.

PhD research
Pel explains: “My research shows that the doctor’s attention should not only focus on the condition or complaint of the person in the examination room, but also on the person themselves. Especially in the geriatric patient target group, having all kinds of different complaints is common. It is not recommended for each specialist to look at each condition individually without taking into account the whole picture of the client and their experiences.”

Tools
Several tools and measuring instruments have been developed to implement Shared Decision Making. Pel: “In the paper, ‘Effects of a shared decision making intervention for older adults with multiple chronic conditions: the DICO study’, published this month, we investigate the impact of these tools. We divided roughly 200 patients into two groups. One was the control group where the doctors were not trained in Shared Decision Making and the patients did not complete the Shared Decision Making Helper, a tool to help patients prepare for the consultation. In the second group of 100 patients, the practitioners had received training in Shared Decision Making and the patients received the Shared Decision Making Helper to complete with family members prior to the treatment consultation. The consultations of both groups were then compared.”

Good and bad news
The results are mixed, according to Pel. “On the positive side, we see that patients who filled out the Shared Decision Making Helper are better able to identify and articulate their goals and options during conversations. The bad news is that physicians who had taken the course, strangely enough, explained less to patients that it was important for patients to actively participate and co-decide. So you need to weigh that against each other for the ‘overall impact’ of Shared Decision Making.”

Follow-up needed
Pel says the article has triggered further development projects for Shared Decision Making. “Clearly, we needed to refine our tools and make them more user-friendly. We have been very busy with that for the past two years. We are encouraging more use among physicians and we are optimising the Shared Decision Making Helper so that it is easier to fill in and apply. We’re definitely going to continue with that.”

Read here the most recent publication on the DICO study.

Read here the dissertation of Ruth Pel-Littel.

The project was a collaboration between -among others- Amsterdam UMC, ACHC, Vilans (Center of Expertise for Long-Term Care), Radboud University and Tilburg University and is supported by ZonMw [Grant Numbers 520002002 and 516000507]