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"Shared Decision Making" What exactly is it? Is there really good value to it?

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Posted 12/18/2013 12:20 AM (GMT -8)
The scope of this article is about the value of shared decision making. It's a trend in care that is being advocated by many people. The value is measured in this article on many levels. The benefit to the patient, the benefit to the finances of that practice, and also the impact on mortality. This was a news release on the ASCO wire that I am privy to due to my membership in that society.

I thought it was beneficial here to point out more reason why a prostate cancer patient should be involved in a shared decision making process that involves the education of a specialist, and also shows how to separate the financial aspect in their personal care.

I take no position in this article other than to point out that the call for more trials to give us better data about shared decision making is a valid point. We don't know the value physically, mentally, or financially.

Here are the other points of this article that are not financial and should not be lost in this discussion:

Dr. Katz made several observations:
1. Studies of shared decision-making do not clearly differentiate (“disentangle”) whether the effects of an intervention can be attributed to patient- or physician-level factors.

2. There is inadequate appreciation of the complexity of how patients construct and express their preferences for treatment.

3. It is assumed, with little evidence, that patient preferences would inherently favor less extensive treatment; to the contrary, some studies suggest patients have unrealistically high expectations about what treatments can offer them.

4. There is an oversimplistic view of the clinical encounter, with blanket assumptions about which conditions or treatments are more or less sensitive to patient preferences.

These points are very interesting to me. It's not why I posted this though. I posted it because I receive this wire and it is a wonderful resource.

If that's vile then I am a vile man.

I actually heard that before. It was on a date when I was young. That turned out to be a good memory.

Tony
Posted 12/18/2013 1:16 AM (GMT -8)

Tim G said...


Tony
I'm also going to go out on a very thin limb and say that more women than men are engaged in medical decision-making. (I've often wondered how involved in decision-making the men are whose wives post here.)

My husband is extremely involved. Actually, he makes the final call.

I do the research until I know just enough to be dangerous and then I report all of my findings to my husband.

We report those findings to the oncologist, who likes that we are "thinking beings." Then the three of us review the pros and cons of each option and come to a consensus.

You see, my husband would rather hook up a high tech home theater that I will never learn how to operate, than to research what he knows I am already researching. Redundancy is a pet peeve of his, unless it involves traveling or depositing checks.

Researching is in my nature and keeping me locked out of changing his television channels or his favorite music, is in his nature. turn
Posted 12/18/2013 4:18 AM (GMT -8)
Tony, I think it was a very interesting article and I enjoyed reading it. Thanks for posting. I stay very involved in the decision making with both my uro and my RO. I dismissed my first Urologist (the one that my biopsy), because he was "telling me" what I was going to do, and not discussing it. I think shared decision making, especially for those of us with "low risk" PCa is very important.

Mike
Posted 12/18/2013 5:26 AM (GMT -8)
Tony, the scope of the article is about the value of shared decision making insofar as it relates to saving costs.

"Dr. Katz recently authored a “Viewpoint” appearing in the Journal of the American Medical Association, questioning the quality of the evidence offered in support of shared decision-making and its benefits to patients, providers, and the health-care system"

"But shared decision-making is also being touted as a strategy to reduce overtreatment and costs. The rationale is that better-informed patients will be more likely to choose more conservative treatments and avoid unnecessary ones."

"the literature does not support its potential to reduce overtreatment and costs.”

“In the age of cost-containment and concerns about overtreatment, we can’t assume that involving patients more in treatment decision-making will help solve these problems,” Dr. Katz said."

There is very little, if anything, that is of actual benefit to the patient in that article.
Posted 12/18/2013 5:54 AM (GMT -8)
The subjects of shared decision making as well as cost containment are both important topics. Whether or not we agree with the position of the authors I feel that this was an important perspective to share with our forum. Tony, thanks for posting it - I found it quite interesting and educational.

Jim
Posted 12/18/2013 8:09 AM (GMT -8)
Before commenting on this thread I did some reading, looking for a quote to use. I found it in a discussion of Gulliver's Travels.

In the section on Lilliput and Blefuscu, Wikipedia said...
[Swift] ... describes an intra-Lilliputian quarrel over the practice of breaking eggs. Traditionally, Lilliputians broke boiled eggs on the larger end; a few generations ago, an Emperor of Lilliput, the Present Emperor's great-grandfather, had decreed that all eggs be broken on the smaller end after he cut himself breaking the egg on the larger end. The differences between Big-Endians (those who broke their eggs at the larger end) and Little-Endians had given rise to "six rebellions... wherein one Emperor lost his life, and another his crown". The Lilliputian religion says an egg should be broken on the convenient end, which is now interpreted by the Lilliputians as the smaller end.

This thread started well enough. The article makes a number of interesting points and the discussion here was initially civil and the disagreements small. But, rather than congratulating ourselves on the broad areas of agreement we seem to have gotten into an all-out pi55ing match, with off-line email name-calling and appeals from both sides to the moderators to make the other guy stop.

*sigh*

I am in the rather uncomfortable position of liking almost everybody in the fracas fairly well. I see everybody's point of view and, frankly, I mostly agree with all of the warring positions because they seem in agreement on the matters I consider substantive and are mostly arguing over minutiae and hurt feelings.

Post Edited (PeterDisAbelard.) : 12/18/2013 9:12:07 AM (GMT-7)

Posted 12/18/2013 10:30 AM (GMT -8)
I share Jim’s appreciation, Tony, for you sharing the valuable insight you have access to.   I always find it interesting to gain an insider’s perspective into the topics of discussion between the learned professionals & industry leaders who are treating us and our brothers.   It is extraordinarily beneficial to those who (like me) are continually learning, growing, and striving for better…
Posted 12/18/2013 11:36 AM (GMT -8)
Ms Worrywart. You described my situation perfectly.. and yet I can not imagine my husband blindly accepting any doctors recommendations. Being low key in this process is a luxury he knows he can afford because he married an Atype personality who is researching EVERYTHING!! I would like to think if I were not around he would do the same for himself, and God forbid our children if the need arose. I do not understand any agreement other than patient and doctor together. Still learning and still figuring things out.

Susan
Posted 12/18/2013 1:07 PM (GMT -8)
Casey59 said...
Patient: Bu my insurance isn't very good!

Doc: Ahhh, don't worry. You're on Facebook, aren't you..."







Patient: Of course I am, Doc.

Post Edited By Moderator (Tudpock18) : 12/18/2013 2:33:44 PM (GMT-7)

Posted 12/18/2013 1:12 PM (GMT -8)
btw, Casey, the guy you are just operate don someone who was upgraded and had extensive cancer caught just in time. The guy now has minimal side effects already.

Post Edited By Moderator (Tudpock18) : 12/18/2013 2:35:23 PM (GMT-7)

Posted 12/18/2013 1:25 PM (GMT -8)
And that's enough.
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