Shared decision making has become an essential part of patient centered care. 

Shared decision making has become an essential part of patient centered care. When shared decision making occurs the patient is part of the health care team. Patients are provided information on their condition and participate in treatment options. As you can imagine, there are widely varying approaches to treatment. To treat or not to treat, may be a decision process we think of more so in patients facing end-stage cancer, for example, and not as commonly with medications for chronic diseases.

            Part of the decision process is comparing treatment options and considering values and preferences of the patient. In deprescribing it may be that a person has been falling or blaming age for an ailment. Options in this case can include stopping a medication that may be increasing falls, changing a medication to a safer option, or reducing the medication to determine if a lower dose may reduce side effects while still providing a therapeutic value. One final option would be to do nothing and potentially experience more falls or ailments that could impact one’s quality of life. 

            By working with the health care team, the patient may feel better if they slowly reduce a medication versus abruptly stopping the medication, especially if they have taken the medication for a number of years. Once a decision is made with the patient and health care team, the last step is to evaluate the change. Monitoring may involve daily at home checks such as blood pressure or self-evaluation of particular symptoms or labs may be necessary to verify outcomes.

            Shared decision making can be used to decide many aspects of health care including tests and screening for a condition with high risk due to genetics such as early onset Alzheimer’s, Huntington’s Disease, and some cancers, for example. Some may choose to “not want to know”, while others “want to know” their risk and if they may be predisposed genetically. Patient’s preferences and values are at the core of this process along with sound, unbiased medical evidence.

            Shared decision making can be empowering. There is no right or wrong choice, however, knowing the facts and making decisions with your health care team is good medicine. Decisions are not finite either, as our preferences and goals may change, or an alternative treatment option may evolve. Keep communications open. Every health care encounter is an opportunity for shared decision making, to ask questions, and to review your medications.

Shared Decision Making Steps for the Patient

  1. Become part of your health care team
  2. Learn about treatment options from your health care professionals
  3. Evaluate and communicate your preferences
  4. Decide on the treatment option with your health care team
  5. Evaluate and monitor the treatment intervention with your health care team
  6. Know that preferences and options may change-keep communications open

Keep reading my weekly blog for more information on the deprescribing process.

In the meantime stay wise and well!