WORKING GROUP NAME: Shared Decision Making

What is Shared Decision Making?

Shared Decision Making is a process in which both the patient and health professional make a decision taking into account the best available evidence on treatment options and the patient’s values and preferences. 

That sounds important.

 Yes! Clinical practice guidelines endorse shared decision making for the management of various rheumatic conditions, such as osteoarthritis (OA), rheumatoid arthritis (RA), psoriatic arthritis (PsA) and juvenile idiopathic arthritis.

 However, it is not always used in clinical practice. So how can we facilitate Shared Decision Making?

There are a few ways (or “interventions”) which may facilitate shared decision making, such as patient decision aids, decision coaching, question prompts and health care professional training.

Some examples of these interventions can be found at:

https://decisionaid.ohri.ca/AZlist.html

https://decisionaid.ohri.ca/coaching.html

Well, that’s good. Are these interventions helpful?

Yes! According to a systematic review that assessed the effectiveness of patient decision aids published by Stacey et. al in 2017:

 “When people use decision aids, they improve their knowledge of the options (high-quality evidence) and feel better informed and more clear about what matters most to them (high-quality evidence). They probably have more accurate expectations of benefits and harms of options (moderate-quality evidence) and probably participate more in decision making (moderate-quality evidence). People who use decision aids may achieve decisions that are consistent with their informed values (evidence is not as strong; more research could change results). People and their clinicians were more likely to talk about the decision when using a decision aid. Decision aids have a variable effect on the option chosen, depending on the choice being considered. Decision aids do not worsen health outcomes, and people using them are not less satisfied. More research is needed to assess if people continue with the option they chose and also to assess what impact decision aids have on healthcare systems.”

Great! But what outcome domains are assessed to determine if a shared decision making interventions work?

Well, in the case of this 2017 systematic review, the outcome domains that were assessed were the following:

• Knowledge
• Accurate risk perceptions
• Informed value-based choice (i.e., match between the option that is chosen and what matters most to the informed patient)
• Decisional conflict (i.e., patients not feeling sure about their best choice)
• Satisfaction with the decision-making process, and
• Adherence to the chosen option

But what outcome domains should be assessed in trials of SDM interventions in rheumatology?

It is not clear which outcome domains of shared decision making interventions are the most important to individuals with a rheumatology condition and to rheumatology clinicians. Also, we are not sure which instruments should be used to measure these outcome domains. It is important to choose the most relevant outcome domains to assess in order to inform clinicians, patients and other key stakeholders of the full value of Shared Decision Making interventions! This may help to implement these interventions in everyday clinical practice.

Is there good news?

 Yes! OMERACT has a great team of volunteers made up of patient partners, clinicians, researchers and policy makers coming from all over the world working to solve this problem!

The aim of this working group is to determine the core set of outcome domains for measuring the effectiveness of shared decision making interventions in rheumatology.