Can shared decision making increase the uptake of evidence in clinical practice?

Abstract

Despite copious research and clear policies in many healthcare systems, evidence based practice has yet to be widely adopted. Part of the problem is insuffi cient consideration of the patient-clinician consultation, which lies at the heart of clinical practice and is where most decisions are made. Shared decision making (SDM)-the interactive process in which patients and clinicians decide on healthcare togethercapitalises on the consultation to better translate the best evidence into clinical decisions while taking the patient's values and preferences into account. This paper takes stock of interventions that seek to embed SDM in clinical practice, such as patient decision aids that target both patients and clinicians. It also presents challenges that remain: among others, the paucity of evidence on effective implementation strategies and the lack of consideration of how SDM works when care is delivered by interprofessional teams. The paper then reviews current initiatives to improve and disseminate SDM across the healthcare continuum, and discusses why SDM should be encouraged as a means to leverage evidence based practice. The evidence suggests that fi nding ways to overcome the challenges and promote SDM will accelerate the uptake of evidence in gastroenterology and hepatology clinical practice.

The Patient Experience: Informing Practice through Identification of Meaningful Communication from the Patient’s Perspective

“…With a political drive to encourage and support the public to be more actively engaged in decisions about their own health [ 10 ], it is important to ensure their expectations are realistic and opportunities for communication are sought without creating barriers to potential patient led improvements [ 48 ]. An ability to communicate in a manner, which identifies the situation from the patient’s perspective, is arguably the pivotal skill required to enable this [ 49 ] with recognition this is particularly difficult when personal characteristics or beliefs differ.…”