Prime Time for Shared Decision Making

Washington State passed legislation in 2007 incentivizing shared decision making as an alternative option to traditional forms and procedures for informed consent for certain procedures. This requires patients to sign an attestation that they used a certified decision aid and discussed risks, benefits, and alternatives. These tools and processes could help protect clinicians from failure to inform litigation. Certified patient decision aids have been used as a model for national certification standards developed by the National Quality Forum. However, the potential for shared decision making to create a more transparent, open process for patients may be hindered by clinicians' lack of experience with these decision aids. There is a need for well-defined standards to ensure policies on shared decision making are implemented without unnecessary burden on clinicians. In order for shared decision making to be effective, the process needs to be clearly described. Shared decision making is defined as a process undertaken between a clinician and patient when there is more than 1 clinically appropriate intervention or management strategy available and through which the patient can decide which choice is best according to their values and preferences. Second, there should be incentives to evaluate and maintain certified decision aids. The National Quality Forum has issued criteria for the certification of patient decision aids. Third, clinician training in shared decision making, including using decision aids, should be promoted. Fourth, there is a need for an agreed-upon method of measurement in shared decision making. Finally, shared decision making should be integrated into clinical practice through positive incentives and while considering the workflow of routine clinical care. Shared decision making has the potential to advance a more patient-centered, value-based health system and to engage patients and reduce costs. Common definitions, trusted certified decision aids, clinician engagement, strategies to enable seamless integration into practice, and a commitment to evaluation and improvement are needed, however, to achieve genuine shared decision making that is embraced by clinicians and patients alike.