Meeting between experts: supporting shared decision-making in practice

In Australia, only around 40% of adults have the level of individual health literacy needed to effectively understand and use information about health. Low health literacy is associated with higher rates of hospitalisation and emergency care, and adverse outcomes more generally. Low health literacy is also associated with lower uptake of preventative health measures.

The Australian Commission on Safety and Quality in Health Care (the Commission) has developed a national program of work on shared decision-making as a part of its commitment to supporting partnerships with consumers, reducing unwarranted healthcare variation and ensuring appropriateness of care.

Shared decision-making happens when a clinician and a patient jointly make a decision about healthcare after discussing the different options for care, the likely benefits and risks of each option, and the patient’s values, preferences and circumstances.¹

Internationally, shared decision-making is seen as a sign of good clinical practice.² It helps clinicians to better understand the patient’s views, helps patients to be better informed about their options and supports patients to be partners in their care, to the extent that they choose, or are able to be.

Shared decision-making can be helpful in a number of clinical situations, particularly where there is more than one reasonable treatment option; when no option has a clear advantage in terms of health outcomes; and where the patient may view the benefits and harms of the options differently from the clinician.³

The potential benefits of shared decision-making include^4,5,6,7,8:

• Improving patient knowledge, risk perception accuracy and patient–clinician communication.
• Reducing a patient’s conflict about making a decision.
• Potentially reducing inappropriate use of tests and treatments.

Tools and resources to support shared decision-making

There are a variety of tools that can be used to assist shared decision-making. Some of the resources the Commission has developed include:

Patient decision aids

Patient decision aids are tools developed for particular conditions or treatments. They can help patients and clinicians draw on high-quality, synthesised information, compare the benefits and harms of each treatment option and clarify patients’ values about what matters most to them.⁹ The Commission has developed three patient decision aids on antibiotic use in the common conditions of sore throat, acute bronchitis and middle ear infection in primary care.

Question Builder

The Question Builder is a web-based tool to assist people to prepare for a visit to a general practitioner or a specialist. The tool, developed in partnership by the Commission and Healthdirect Australia, supports people to build a list of questions that they would like to ask their doctor, and to consider questions that their doctor may ask them.

Top tips

The Commission has also developed ‘Top tips for safe health care’, a resource designed to assist consumers, their families, carers and other support people to ask questions, understand their rights and provide feedback about their experiences in healthcare.

Training for clinicians

The Commission, in collaboration with experts, clinical colleges, education groups and consumers, has developed an online training module for clinicians on the best ways to communicate risks and benefits to patients. The initial version was released on gplearning in July 2016 and a second version is being produced with several specialist colleges for release later this year.

About the Commission

The Australian Commission on Safety and Quality in Health Care is an Australian Government agency that leads and coordinates national improvements in the safety and quality of healthcare based on the best available evidence. By working in partnership with patients, consumers, clinicians, managers, policymakers and healthcare organisations, the Commission’s aim is to achieve a sustainable, safe and high-quality health system. The Commission has an ongoing program of significant national activities with outcomes that are demonstrating direct patient benefit as well as creating essential underpinnings for ongoing improvement.

The Commission aims to use its role as the national body for safety and quality in healthcare in Australia to ensure that the health system is better informed, supported and organised to deliver safe and high-quality care.

[1] Hoffmann TC, Legare F, Simmons MB, et al. Shared decision making: what do clinicians need to know and why should they bother? The Medical journal of Australia. 2014; 201: 35-9.

[2] Elwyn G, Tilburt J, Montori V. The ethical imperative for shared decision-making. European Journal for Person Centered Healthcare. 2013; 1: 129-31.

[3] Stacey D, Legare F, Col NF, et al. Decision aids for people facing health treatment or screening decisions. The Cochrane database of systematic reviews. 2014; 1: CD001431.

[4] Coulter A, Collins A. Making shared decision-making a reality: No decision about me, without me. London: The King’s Fund; 2011.

[5] Hoffmann TC, Legare F, Simmons MB, McNamara K, McCaffery K, Trevena LJ, et al. Shared decision making: what do clinicians need to know and why should they bother? Med J Aust. 2014; 201(1):35-9.

[6] O’Shea E. Communicating Risk to Patients. Dublin: Irish College of General Practitioners, Quality in Practice Committee, 2014.

[7] Stacey D, Legare F, Col NF, Bennett CL, Barry MJ, Eden KB, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2014; 1:CD001431.

[8] Da Silva D. Evidence: Helping people share decisions. London: The Health Foundation, 2012.

[9] Hoffmann TC, Legare F, Simmons MB, et al. Shared decision making: what do clinicians need to know and why should they bother? The Medical journal of Australia. 2014; 201: 35-9.

Image credit: ©stock.adobe.com/au/Monkey Business