Shared decision making is a collaborative process that involves patients and physiotherapists making health-related decisions together after discussing and considering several things:
- the available options for treatment;
- the benefits and harms of each treatment option; and
- the patient’s values, preferences and personal circumstances.
Shared decision making is therefore a means of translating evidence into practice and facilitating patient-centred care by helping patients to become more active in the process of making decisions about their healthcare management. Ideally, a shared decision incorporates the best available research evidence, the physiotherapist’s knowledge/expertise, and the patient’s values/preferences.
A recent Masterclass paper in the Brazilian Journal of Physical Therapy explains what physiotherapists need to know about the process of shared decision making.
The paper explains several reasons why shared decision making is important. It can result in higher patient and physiotherapist satisfaction. It acknowledges that both the physiotherapist’s perspective and the patient’s perspective are important, which can help to equalise any unequal power relationship in the clinical setting. It thereby facilitates good patient-therapist communication, enabling patients to make an evidence-informed decision. It also helps to promote realistic expectations and beliefs about interventions, how they can help and how much effect they are likely to have.
The majority of patient healthcare complaints are due to ineffectual communication or receiving an inadequate amount of information to make an informed decision. Shared decision making works to mitigate this situation by facilitating good patient-therapist communication and enabling patients to make an evidence-informed decision.
A helpful section in the paper considers situations where shared decision making might be more or less appropriate. For example, it is not needed (and therefore less appropriate) in circumstances where there is one clearly superior treatment option. It is most relevant when there are two or more options with similar effectiveness but different costs or different types of benefit or harm). In such situations, there is a need for a value judgement – and the physiotherapist can assist the patient to arrive at that judgement by explaining the evidence in a comprehensible way and by using their experience and expertise to help the patient reason appropriately when considering how that information applies to their own situation.
A flow diagram shows the key elements of the shared decision making process in a typical order in which they might occur. The authors point out, though, that it is often not a linear process and some elements may be revisited before the final decision is made.
The examples discussed above relate to shared decision making about treatments, but shared decision making also applies to screening procedures, diagnostic tests and prevention strategies. For example, the procedures involved in undergoing a diagnostic test may involve some risk of an adverse event, so patients may also benefit from the opportunity to discuss with their physiotherapist the evidence about the test’s performance, the importance of the information the test will provide, and the implications of the different possible test results before deciding whether to have a test. A nice aspect of the paper is that it is written to encompass all of these aspects of shared decision making.
The paper also reviews the evidence about physiotherapists’ use of shared decision making, available resources to facilitate shared decision making, and studies of interventions to increase use of shared decision making in physiotherapy.
Hoffmann T, et al. Shared decision making and physical therapy: What, when, how, and why? Braz J Phys Ther 2021 Dec 31:Epub ahead of print.