Shared decision-making can significantly lower the probability that patients will file lawsuits and complaints, according to a simulation study.
Multiple benefits have been associated with shared decision-making, such as facilitating patient-centered care and managing overutilization of lab tests as informed patients forego invasive exams.
Shared decision-making provides clinicians with a measure of legal relief, researchers wrote in the Annals of Emergency Medicine. “Although intent as reported on a survey does not always predict behavior, our results suggest that the use of shared decision-making confers medicolegal protection in the event of an adverse outcome,” they stated.
The researchers used a web-based research recruitment platform to enlist 800 study participants. The participants were surveyed after completing decision-making vignettes for an appendicitis scenario.
They reported that study participants who engaged in brief or thorough shared decision-making were 80% less likely to want a lawyer than participants who did not engage in shared decision-making.
“Participants exposed to either level of shared decision-making reported higher trust, rated their physicians more highly, and were less likely to fault their physicians for the adverse outcome compared with those exposed to the no shared decision-making vignette,” the researchers wrote.
Lead author Elizabeth Schoenfeld, MD, an assistant professor in the department of emergency medicine at UMass Medical School-Baystate in Worcester, Massachusetts, said there are three primary barriers to shared decision-making.
Find the Time
“Clinicians feel that shared decision-making takes up too much time,” Schoenfeld said, adding that it takes organizational commitment to include patient preferences in decision making.
“We can’t just create work-arounds, like sending patients decision aids in the mail, or having a non-clinician start the shared decision-making process. We have to actually commit to giving clinicians time to have these conversations,” she stated. “Clinicians, for their part, can get better at having these conversations efficiently, but a conversation will always take longer than a directive.”
Weigh the Options
Clinicians often feel shared decision-making is inappropriate because the options are not equally advisable, she said.
“The clinician thinks that option A is probably better for the patient than option B, and therefore doesn’t want to discuss the options. The problem with this is that many of our ‘medically reasonable’ decisions have consequences to patients that we have either not considered or have not given sufficient weight.”
Clinicians need to commit to shared decision-making even when they think one option makes more sense, Schoenfeld stressed: “We need to remember that decisions that seem straightforward to us may be less so when the patient’s preferences are considered.”
Encourage Patient Participation
Many clinicians assume that some of their patients do not want to be involved in shared decision-making, but patients want to be involved in decisions when they understand the consequences, she said.
“This means that clinicians should err on the side of thoroughly explaining options and consequences before they seek patient feedback,” Schoenfeld said. “It also probably reflects that we could all be better at communicating medical decision-making.”
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