Shared decision-making experienced by Canadians facing health care decisions: a Web-based survey

Abstract

anadians need support in health-related decisionmaking.¹ More than half of Canadians experience decisional conflict after having made a complex health decision. 1 Many of the decisions patients face present multiple options, there is incomplete or conflicting evidence about possible outcomes, and expectations are often unrealistic. 1,2 Shared decision-making is a process whereby health care professionals and patients work jointly to make health care choices, considering best clinical evidence as well as patients' values and preferences. 3 It constitutes a key component of patient-centred care 4 and results in better health care choices, with demonstrated benefits and less practice variation. 5 Several reasons, such as time constraints, have been raised to explain a lack of implementation of shared decision-making in daily clinical practice. 6 However, most reasons are not evidence-based and are often based on misconceptions. 7 Although previous surveys and studies have reported on the level of shared decision-making in diverse health care settings, 8,9 we know little from a population-based perspective in Canada. Therefore, we aimed to assess how much shared decision-making Canadians experienced in health-related decisions and to explore variations across sociodemographic factors, jurisdictions and care settings.

Understanding the public’s role in reducing low-value care: a scoping review

“…Moreover, the small group of studies that examined the perspectives of patients, caregivers, and clinicians regarding the use of these tools reported that they support their use. Yet, shared decision-making is underused in clinical practice [51][52][53], likely due to the time and resources required in order for it to be effective [54]. Embracing shared decision-making as a strategy for reducing low-value care will require appropriate infrastructure within the healthcare system and cultural shift among patients and clinicians; however, as highlighted in a recent commentary on the complexities of deimplementation [15], taking such measures to address patient-level factors that affect de-implementation will be the key to the success of future de-implementation initiatives.…”

Decisional needs assessment of patients with complex care needs in primary care

“…Clinicians lack understanding of the decision‐making needs faced by primary care patients with complex care needs, which increases the imbalance between their needs and the services currently offered by interprofessional teams. This is an important issue to address because it is now known that Canadians experience a low degree of SDM, and that most patients do not have the opportunity to talk about their preferences in terms of care and treatment. Patients could greatly benefit from the SDM approach, but it is often unknown to health care professionals and requires to be well informed about the “real‐life” of living with a complex health condition .…”

“…Patients could greatly benefit from the SDM approach, 27,28 but it is often unknown to health care professionals and requires to be well informed about the "real-life" of living with a complex health condition. 23 The SDM approach is underutilized among vulnerable clienteles 3,29 ; health professionals presume that they wish to be less active in decision making about their health care. 30 The huge number of decisions faced by patients in our study supports that patients would benefit from a Patient Decision Aid (PtDA) to discuss engaging or not in a decision making case management program.…”

“…It allows patients to improve their knowledge of available options, clarify what matters most to them so their choices are evidence‐informed and congruent with their values . However, SDM is yet to be the norm in health care and the most vulnerable Canadians are not benefiting from SDM …”

“…2 However, SDM is yet to be the norm in health care and the most vulnerable Canadians are not benefiting from SDM. 3 Effective SDM implementation strategies include patient (Pt) decision aids (DA). 4 PtDA are evidence-based tools designed to help patients make specific and deliberate choices among health care options.…”