Prime Time for Shared Decision Making

Abstract

The recognition that informed patients often choose more conservative and hence less expensive medical options has made shared decision making a focus of valuebased care. 1 In 2007, Washington State passed legislation incentivizing shared decision making as an alternative to traditional informed consent procedures and forms for preference-based treatment decisions that include an elective procedure, such as joint replacement for hip or knee osteoarthritis. 2 To qualify as this alternative to traditional informed consent, clinicians are required to use a certified decision aid to facilitate discussion about the different treatment options and patients need to sign an attestation that they reviewed the decision aid with the clinician, discussed the alternatives, risks, and benefits, and decided on a specific course of action. Clinicians who practice shared decision making will be presumed to have engaged patients in an informed consent process regarding the elective procedure and will be provided with increased protection against potential ensuing litigation based on failure to inform. Specifically, the use of the tools and the process associated with this use would shift the burden in litigation to patients to demonstrate clear and convincing evidence that they were not informed. 2 In 2016, Washington State certified the first decision aids in maternal-fetal care related to decisions for birth options after cesarean delivery, for amniocentesis, and for genetic screening.Washington State's unprecedented legislation coincides with national activity. The National Quality Forum recently developed national certification standards for patient decision aids based on those used in Washington State. 3 The Centers for Medicare & Medicaid Services (CMS) announced shared decision making as a precondition for payment for low-dose computed tomography scans for lung cancer screening and for left atrial appendage closure, and recently announced 2 shared decision making models for beneficiary engagement that focus on 6 preference-sensitive conditions: stable ischemic heart disease; hip osteoarthritis; knee osteoarthritis; herniated disk and spinal stenosis; clinically localized prostate cancer; and benign prostatic hyperplasia. 4 Additionally, the recent Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) included shared decision making in 1 of 4 performance categories used to determine clinician reimbursement under the Merit-Based Incentive Payment System. Even as shared decision making expands, 5 most clinicians and health centers outside the research setting have limited experience with decision aids, which may undermine the potential for shared decision making to engage patients in an open, transparent manner about health care choices.Clinicians who will be incentivized to use shared decision making may have misconceptions about what it is and skepticism of its value. Well-defined standards are needed to help translate new policies into clinical prac-VIEWPOINT

Shared decision‐making in peri‐operative medicine: a narrative review

“…In recent years, the medical decision-making community has largely shifted from examining the concept of shared decision-making and its potential effects to pushing to implement it in practice [39,40]. The most common type of intervention used to pursue implementation of shared decision-making has been the decision aid.…”

The Times they Are a-Changin’ – Healthcare 4.0 Is Coming!

“…The precision medicine guides the treatment by using more comprehensive molecular diagnoses, e.g., genotype, protein expression, and RNA expression [14]. The artificial intelligence and big data refine the diagnostic (e. g., enhance lesion boundary and suggest diagnosis) and treatment procedures; the patients cooperate with doctors by shared decision making [15]. Telemedicine will make seeing or being seen easier, and of course, all these will not happen without the internet of things [16].…”

The Times They Are a-Changin� � Healthcare 4.0 is Coming! (Preprint)

“…The artificial intelligence and big data refine the diagnostic (e. g., enhance lesion boundary and suggest diagnosis) and treatment procedures; the patients cooperate with doctors by shared decision making [15]. Telemedicine will make seeing or being seen easier, and of course, all these will not happen without the internet of things [16].…”