Shared Decision Making vs. Informed Consent. What’s the Difference and Who Cares?

I was talking to some PA-Cs a while back and the subject of shared decision-making (SDM) came up and I was surprised by their responses. Most thought it was something that health care providers had been using for decades.
“Just yesterday I sat down with a patient before surgery and told them all of the things that could go wrong if we replaced their joint as well as the benefits. We’ve been doing that forever. It’s all part of informed consent.” - one the the PA-Cs
This provider is right. What was mentioned above IS part of informed consent. But informed consent and SDM are the not same. Hopefully this post will help to clear up some of the confusion.

A.When is the SDM model appropriate?
1.SDM should be used with Preference Sensitive Care decisions, NOT Effective Care decisions.
Effective Care = there is a medically indicated course of action in which benefits have been shown to outweigh risks. In these cases patients will follow their provider’s advice. [Example: Newborn vaccinations]
Preference Sensitive Care = there are multiple (or at least more than 1) medically reasonable options.  [Example: Prostate surgery or watchful waiting after receiving an elevated PSA result]
2.SDM should be used when a patient is not 100% certain about their decision. Perhaps there is no “right” answer, family pressures, or strong emotional ties that make decision making hard.
B.What is the difference between SDM and informed consent/patient education?
In informed consent/patient education, the education typically focuses on informing about a specific option and the risks and benefits of that option.  SDM, on the other hand, attempts to present balanced evidence based information about all reasonable options as well as incorporate the patient’s values into the decision making process.  The encouragement of patients to become active in the process is crucial.
C.Who cares?
By treating patients with unresolved conflicts, we as providers open up ourselves to patient dissatisfaction, patients changing their minds, higher rates of delayed decision making, and blame for bad outcomes (aka legal action). If by simply changing our approach to care delivery we could gain better results – Why aren’t more people on board?
I will continue to write on this subject. Consider this a teaser, a toe dip, a trailer. I look forward to comments or experiences that you’ve had with health care providers that have used SDM or just informed consent. I will also include some great resources for SDM in future posts.

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