Welcome to Health Literacy Month. This year, we’ll look through the lens of health literacy to think about shared decision making. On the face of it, the shared decision making equation seems simple:
But there are health literacy issues on all sides.
There are numeracy challenges not just for patients, but practitioners as well. Patients desperately want to understand the risks and common outcomes of each treatment option. But physicians and researchers often need to unpack the numbers across multiple studies. And sometimes the numbers simply don’t exist — at least not in the straightforward way people want or need them. Other times, a doctor’s own experience with specific patients can influence how they think about or explain the numbers. And patients often see themselves as the exception to the numbers. And who hasn’t had the thought, if one in 15 die from this, I could be “the one”?
For example, if a 15-minute program or video goes over three options for prostate cancer: watchful waiting, radiation, and prostatectomy, it’s natural to spend less time explaining watchful waiting. There’s just not that much to go over — no big procedure to explain, not a lot of possible side effects, etc. But the time needed to explain what prostate surgery is, the risks and recovery usually just takes longer.
However, in focus groups we found that if we don’t spend almost the same amount of time talking about watchful waiting, even though there was less to explain, men felt it wasn’t a “real option”, or it must not be a good option – or even voiced concern the program may be biased against it. So in this case, time spent truly seemed to affect patient perceptions and understanding of their treatment options.
There are also common biases and preconceptions people have about treatments. If you know that many women believe the most aggressive treatment will give them the best chance of survival (say a mastectomy vs. lumpectomy), how do you account for that pre-existing bias in the shared decision making process?
So while shared decision making is not new (and really sounds a lot like a good practitioner having a meaningful conversation with a patient), the art and science of shared decision making still faces a steep learning curve. And there may not be one best way for the variety of decisions that exist.
Throughout the month you’ll hear a variety of insights and perspectives. In the spirit of shared decision making, please participate. Your questions, real experiences, and opinions can only move us further along the path of understanding what works.
Geri Baumblatt, Editorial Director
Excellent points. In order to expedite the creation of patient decision tools, there’s a desire to create a standard template. But as you write, “There may not be one best way for the variety of decisions that exist.” One size template doesn’t fit all decisions. We need to build in room for flexibility to account for the fact that each decision comes with its own “baggage.”
Reblogged this on lava kafle kathmandu nepal.
I think you bring up great points. Shared decision making seems to be ideal in theory but may have too many external factors to ever be a consistent method. However, I think the key is that information is not given in a “straightforward way people want or need them”. There is no denying that the way material is presented can have drastic effects on how the patient perceives it. With that in mind, there are three main things that come to mind that are of utter importance when relaying a message on a patient’s future options.
First, the information presented to the patient must not be biased. The physician must look to avoid putting too much weight into his or her own experiences. By finding unbiased and reliable data on the topics the physician is going to discuss with his patient, they are both put in a position to make the more logical choice.
Secondly, the patient must be on the same page as the physician. I think that it is crucial for the physician to start the conversation by trying to fight any preconceived notions a patient may have about procedures or medications. With all the “doctor shows” flooding daytime television and the deceiving medication advertisements, its vital to make sure the patient knows facts and not the media distortions. The best way to do this is to put facts in lay terms for the patient, making sure that even the smallest of details are covered.
Lastly, the way the options are presented must be simplistic and applicable to the situation. Once the physician and patient are both on the same page with factual data and a thorough understanding of the procedures and medications, graphical representation can be utilized to accompany a doctor’s breakdown of the options. Doing this will make the patient less likely to misinterpret or think of themselves as “the one”. Plotted data or charts are exponentially more effective forms of communication than a chart full of numbers or drowning the patient with percentages and statistics.
Although this may be difficult to achieve under certain circumstances, trying to fulfill these “checkpoints” when utilizing shared decision making can make the process more effective and worthwhile.
You bring up a lot of great points. But it turns out to be more challenging than most people think to create materials that are unbiased and also SEEM unbiased to patients.
I think it would be easy for a physician to spend 5 minutes covering something like watchful waiting and not realize if they then spend 10 minutes explaining more complex info, that some people may perceive watchful waiting as a less viable option.
Another interesting study presented at last year’s SMDM conference in Chicago, when physicians disclosed to patients that they as the doctor would be paid a small fee if the patient joined a study, they found patients were actually MORE likely to join the study because they wanted their doctor to like them. This is the opposite of what was expected: that patients would be offended and feel their physician may be referring them for personal gain.
So how people perceive the information, their relationship to and trust of the one who presents it or gives it to them all seem to impact whether the patient thinks it’s truly unbiased information.
[...] Geri Baumblatt: “Shared Decision Making Through the Lens of Health Literacy” [...]