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More doctors, patients working together to make medical decisions

David M. Levine

Doctors and patients are more frequently engaged in the shared decision-making process now than they were in the past, according to findings recently published in Annals of Family Medicine.

“There has been an enormous push to use shared decision making in clinical practice because of research that has shown it improves patient knowledge, reduces uncertainty, and reduces overuse,” David M. Levine, MD, MPH, MA, of Harvard Medical School and the division of general internal medicine at Brigham and Women’s Hospital, told Healio Family Medicine. “However, little [is] known how use of shared decision making has changed nationally over time.”

Researchers compiled data from national Medical Expenditure Panel surveys from 2002 (n = 12,138) and from 2014 (n = 9,049) and developed seven-point composite scores based on the following survey questions:

Did your clinician:

• Present all options to you? (yes/no);
• Spend enough time with you? (never/sometimes/usually/always);
• Display respect for you? (never/sometimes/usually/always);
• Explain things so they were easy to understand? (never/sometimes/usually/always);
• Listen carefully to you? (never/sometimes/usually/always);
• Display respect for alternative treatments? (never/sometimes/usually/always); and
• Ask you to help decide? (never/sometimes/usually/always)

Levine and colleagues found that when comparing 2002 to 2014:

• The proportion of participants giving ‘always’ or ‘yes’ answers to the seven questions significantly increased.
• The mean shared decision making composite score increased from 4.4 (95% CI, 4.3-4.4) to 5 (95% CI, 4.9-5.1) out of 7 points.
• Independent predictors of higher shared decision-making scores included calendar year (+0.04 points/year), having a usual source of care that was the same race as the participant (+0.24 points), and black vs. white race (+0.33 points) (P < .05 each).
• Characteristics independently linked to lower shared decision-making scores included not having insurance (–0.17 points), Asian vs. white race (–0.28 points) and poor sense of health (–0.41 points) (P < .05 each).
• Survey participants were less likely to have private insurance, be white and have a usual source of care, and were more likely to have more education, be older and be Hispanic (P < .05 each).

“This paper should hopefully serve to emphasize that shared decision making should be a regular practice between clinician and patient, and that if it is not, the two should work toward improvement,” Levine said in an interview. “A primary care physician can reflect on how often [she or he] are practicing shared decision making, and particularly if there are certain patient populations with whom [she or he] increase or decrease shared decision making. Obtaining training/coaching where disparities may exist could mean better outcomes for subsets of his [or] her patients.” – by Janel Miller