[td_block_51 cstm_author_id="Beth Faiman, CNP, PhD"]
In this edition, ASH Clinical News Associate Editor Beth Faiman, CNP, PhD, describes the role of shared decision-making in a patient-centered encounter.
Most people have heard about the topic of shared decision-making (SDM), when patients and providers discuss treatment options and mutual goals to arrive at the “best” treatment decision for the patient. SDM has been recognized as an important component of a patient-centered encounter, and numerous studies have highlighted the benefits of SDM across disease states, including improved treatment adherence, less patient decisional regret, and decreased health expenditures.1 The Centers for Medicare & Medicaid Services validated the importance of SDM in 2015, when it required the practice as a condition of reimbursement for lung cancer screening. Failure to document the SDM discussion can lead to denial of coverage of services. And in 2018, a revised Medicare coverage policy for implantable cardioverter-defibrillators mandated an SDM interaction be conducted and documented prior to implantation of the device for primary prevention of sudden cardiac death. In the era of high costs of services (such as chimeric antigen receptor T-cell therapy) and the potential decrease in health-related quality of life with cumulative treatments over time, are hematologists at risk for similar SDM mandates to ensure patients are fully aware of the trade-offs of therapy? What Does an SDM Encounter Look Like? Whether it is formally acknowledged or not, most hematology practitioners employ the principles of SDM in routine clinical practice. For example, many centers mandate that a patient and provider sign a consent form before starting intravenous chemotherapy. Obtaining consent in this way can be thought of as a first step to a complete SDM discussion. The health care provider could easily take the process further to make sure the patient and caregiver are fully informed and knowledgeable about potential side effects, patient burden (such as trips to the hospital, which often also affect the caregiver), or the need to take daily oral medications with potentially high out-of-pocket copays. There are several strategies to enact SDM in daily practice, but the easiest for me to adopt was the SHARE Approach, developed by the Agency for Healthcare Research and Quality (AHRQ). This comprehensive tool was designed to help health care providers have an SDM dialogue with patients about their potential treatment options and, ultimately, decide which best suits their treatment goals (FIGURE). Here is a three-step example of a successful SDM encounter in the real world:
- The physician or health care provider reviews treatment options with the patient, then tells the patient why one treatment is better than the other, based on his or her knowledge of research data, assumed patient preferences, and available treatments and clinical trials.
- The patient and/or caregiver becomes engaged in the discussion and asks appropriate questions. Is the health care provider’s recommendation based on efficacy? Safety? Or perhaps quality versus quantity of life? What are the risks/trade-offs with the more efficacious procedure?
- The patient and health care provider mutually agree to initiate treatment after a discussion of the risks, benefits, and alternatives to various treatments, often with a check-in to review the decision after the new treatment has started.
- Faiman B, Tariman JD. Shared Decision Making: Improving Patient Outcomes by Understanding the Benefits of and Barriers to Effective Communication. Clin J Oncol Nurs. 2019;23:540-2.
- van Balen EC, Krawczyk M, Gue D, et al. Patient-centred care in haemophilia: Patient perspectives on visualization and participation in decision-making. Haemophilia. 2019 September 17. [Epub ahead of print]
- Burkhalter JE, Aboulafia DM, Botello-Harbaum M, Lee JY. Participant characteristics and clinical trial decision-making factors in AIDS malignancy consortium treatment trials for HIV-infected persons with cancer (AMC #S006). HIV Clin Trials. 2018;19:235-41.
- Nejati B, Lin CC, Aaronson NK, et al. Determinants of satisfactory patient communication and shared decision making in patients with multiple myeloma. Psychooncology. 2019;28:1490-7.
- Rocque GB, Williams CP, Halilova KI, et al. Improving shared decision-making in chronic lymphocytic leukemia through multidisciplinary education. Transl Behav Med. 2018;8:175-82.
- Crawford R, Sully K, Conroy R, et al. Patient-centered insights on treatment decision making and living with acute myeloid leukemia and other hematologic cancers. Patient. 2019 August 28. [Epub ahead of print]
- Chari A, Romanus D, DasMahapatra P, et al. Patient-Reported Factors in Treatment Satisfaction in Patients with Relapsed/Refractory Multiple Myeloma (RRMM). The Oncologist. 2019 August 1. [Epub ahead of print]
- Seitzler S, Finley-Oliver E, Simonelli C, Baz R. Quality of life in multiple myeloma: considerations and recommendations. Exp Rev Hematol. 2019;12:419-24.