The National Institute for Health Care Reform has issued a policy analysis of the issue of shared decision making by physicians and patients. The concept of shared decision is a key innovation in many models of patient-centered medical homes, based on evidence that more informed and engaged patients are more likely to understand and comply with treatments prescribed. A key tenet of shared decision making is strengthening the patient-clinician relationship, with the clinician in the role of advocate/guide and the patient as informed decision maker.
However, physicians and other clinicians face barriers to using shared decision making, including lack of reimbursements under a fee-for-service payment system that rewards higher volumes of service, insufficient training tools to weigh evidence and techniques to discuss options for preference-sensitive treatment with patients, and concerns about malpractice liability based on state laws governing informed consent. On the other hand, patients face barriers of low health literacy and low numeracy, and are afraid that they will be denied needed care.
The policy analysis notes that the Patient Protection and Affordable Care Act (ACA) authorized the development of standards for patient-decision aids and the certification of these tools by an independent entity. Unfortunately, Congress has not appropriated the necessary funding to implement these tasks. The analysis also notes that when shared decision making could be included as part of other payment reforms and medical liability reform. Other sections of the ACA that support patient-centered outcomes research may also build the evidence on which shared decision making may be made.
The National Institute for Health Care Reform is a non-partisan organization established by the International Union, UAW, Chrysler Group, Ford Motor Company, and General Motors. It contracts with the Center for Studying Health System Change to conduct health policy research and analyses to improve the organization, financing, and delivery of health care in the U.S.