Shared decision-making allows better diabetes self-management
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Susan Weiner, MS, RDN, CDCES, FADCES, talks with Lucille Hughes, DNP, MSN/ED, CDCES, BC-ADM, FADCES, about the benefits of collaborating with people with diabetes in their own self-management of the disease.
Weiner: What is shared decision-making and why is it important?
Hughes: Shared decision-making is a critical component of person-centered care. Although the framework has been understood for many years, it has not been widely adopted into practice. With shared decision-making, the health care professional collaborates with the person with diabetes to make health care decisions. They work together to determine which treatments, medications, etc, may be necessary, while always balancing the preferences, values, limitations and desires of the person with diabetes.
Shared decision-making is best understood using two premises:
- Individuals equipped with relevant and detailed information can and will participate in medical decisions about their care by asking questions and sharing their own personal values and opinions with their health care professional.
- Health care professionals will respect the individual’s goals and preferences and utilize those insights to guide recommendations and treatments.
The key to successful shared decision-making is excellent listening. Unfortunately, to compensate for limited time, health care professionals often find themselves “telling” the person with diabetes what they want them to know, instead of “asking” the person what they want us to know.
Weiner: How can shared decision-making improve a person’s relationship, trust and rapport with the health care team?
Hughes: When shared decision-making is properly implemented, the person seeking medical guidance does most of the talking and the health care professional listens. When people feel they have a valued voice in their care, it builds rapport and trust. Feeling heard and valued decreases anxiety and increases confidence in their ability to self-manage their medical condition. Allowing the person to be a partner in their care, improves collaboration with the care team and empowers the person to adopt behaviors that will lead to positive health outcomes.
Weiner: Does shared decision-making improve care and frequency of follow-up visits?
Hughes: Absolutely it does. When people feel appreciated, respected and valued, they are not afraid to return for a follow-up visit. Instead, they look forward to sharing positive successes as well as struggles and challenges with their health care professional and health care team.
Here’s an example:
Upon reviewing a person’s downloaded continuous glucose monitoring data, the health care professional sees what appears to be a day that has the least amount of glucose variability. When employing shared decision-making, never assume — simply start the conversation by asking about this day. The person may respond that on this day they were very mindful of their carbohydrate intake, that they engaged in physical activity and planned their snacks. At the end of the discussion, you can both agree that this day was a day with positive behaviors worth repeating.
In contrast, imagine the person states, “This was 2 days before I got paid. I had only canned soup in my house and ate only one meal that day.” Would you still consider this a day with behaviors you or the person would want to repeat? At the end of this discussion, you can both agree that this was, in fact, a challenging day. If a person shares they are struggling with food insecurity, you now have the information for further discussion.
The goal is to collaborate and explore options and opportunities that meet the needs of the person with diabetes and reflect what is important to them.
Weiner: What other metrics are affected by shared decision-making?
Hughes: Shared decision-making has the potential to influence many metrics. For example, when a person with diabetes creates and agrees to a nutrition plan or a physical activity plan, they are more likely to follow it. Successful meal planning and physical activity will affect important metrics such as weight, HbA1c, blood pressure and psychological well-being.
Weiner: Can shared decision-making reduce economic burden and increase practice revenue?
Hughes: Imagine the reduction in economic burden when chronic diseases and their complications improve and use of unnecessary medications decreases. On the other hand, imagine the increase in practice revenue when a person with diabetes attends office visits, when they have blood work done as prescribed. Think of the efficiency in practice operations when people with diabetes attend their visits and no-show rates decline. A productive staff equates to a productive office, and an increase in patient satisfaction leads to an increase in referrals and revenue.
Weiner: As a health care professional, what do you when you consider a person’s decisions about their own care to be detrimental?
Hughes: As health care professionals, we share the desire to see the people we collaborate with make informed decisions that result in the best health outcomes; however, there will be situations when the person with diabetes may make a decision that may pose a potential conflict with health outcomes. Keeping in mind, in a court of law, competent people can make their own decisions, regardless of consequences. This reality may pose challenges for the health care professional. We wonder at what point do we surrender to patient autonomy and be satisfied that we have fulfilled our ethical obligations?
The first challenge in situations such as these is to ensure the person with diabetes has been provided adequate information to make an informed decision. Secondly, did we allow the person to share their viewpoint, their health goals, their concerns, etc? Did we listen?
And lastly, when implementing shared decision-making, is the person actually competent to make decisions? Dealing with caregivers, such as family members, friends, agency, adds another layer of complexity. Do these individuals truly understand and represent the voice of the person with diabetes?
Time and further discussion with all individuals are often required in these challenging situations. Most importantly, once you believe the person or caregiver has been heard and respected, the final step is to value their decision and verbalize that to them. These are the tenants of shared decision-making.
For more information:
Lucille Hughes, DNP, MSN/ED, CDCES, BC-ADM, FADCES, is director of diabetes education at Mount Sinai South Nassau in New York. She can be reached at lucillehughes5@gmail.com.
Susan Weiner, MS, RDN, CDN, CDCES, FADCES, is co-author of The Complete Diabetes Organizer and Diabetes: 365 Tips for Living Well. She is the owner of Susan Weiner Nutrition PLLC and is the Endocrine Today Diabetes in Real Life column editor. She can be reached at susan@susanweinernutrition.com; Twitter: @susangweiner.
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