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Getting Started with Shared-Decision Making (SDM)

Congratulations on taking the first steps towards incorporating SDM into your practice! You and your patients will be glad that you did.

Mindset

SDM starts with you. Developing these skills is vital to providing the very best patient care.

Look for opportunities

Like so many of us in clinical practice, you're a busy person. You likely see a large number of patients, a variety of conditions at different stages, and face making many decisions.

You base your recommendations on the best available evidence. And the evidence shows that the best outcomes occur when patients 'buy-in' to their care, with an approach that is a 'best fit' with their personal values and care preferences.

Some example opportunities to involve patients and their caregivers include:

Considering insulin for type 2 diabetes or a statin for hyperlipidemia.
Timing and extent of cancer screenings.
Discussing care preferences and advanced care planning.
Discussing healthy lifestyle choices and weight loss.

Know the SDM basics

Invite your patient to take part in the decision-making process.
Ask what they understand about their health, particularly related to the current health issue(s). Ask them what's important regarding their goals, values, and concerns.
Present all reasonable options in simple, clear, easy-to-understand language
Help patients assess each option in the context of their goals, values, concerns. If a patient isn't sure, it's reasonable to offer suggestions that align with their care preferences/values.

More SDM tips for generalists

Speak slowly and avoid complex medical terms.
Use active listening and provide information in small segments, giving the patient time to think and respond.
Use teach-back to assess the patient's understanding of their options.
You may also want to consider having access to interpreter services or visual aids.

If you'd like more practice to develop your skills, see our SDM Skills Course.

Mindset

SDM starts with you. Developing these skills is vital to providing the very best patient care.

Look for opportunities

Your patients may need to make crucial decisions about their health and treatment options. They may feel overwhelmed.

You're seeing the patient not only because of your specialized skill set but also because of the complexity of their situation. There may be more than one reasonable approach/treatment plan.

Some example opportunities to involve patients and their caregivers include:

Deciding about treatment(s) for breast cancer.
Deciding about taking medication during pregnancy.
Deciding between surgery or medical treatments for a condition.
Discussing advance care planning.

Know the SDM basics

Invite your patient to take part in the decision-making process.
Ask what they understand about their health, particularly related to the current health issue(s). Ask them what's important regarding their goals, values, and concerns.
Present all reasonable options in simple, clear, easy-to-understand language
Help patients assess each option in the context of their goals, values, concerns. If a patient isn't sure, it's reasonable to offer suggestions that align with their care preferences/values.

More SDM tips for specialists

When partnering with a patient who's facing a difficult decision, invite family, caregivers, primary care providers, and/or trusted community supports (e.g. therapist, care manager, religious leaders) to be part of the discussion.
Provide the most up-to-date evidence on the risks and benefits of each option, as well as the best, worst, and most likely potential outcomes.
Consider the patient's goals and values before assuming there's one “correct" treatment. It can be helpful to include no disease-focused treatment/best supportive care as an option.

If you'd like more practice to develop your skills, see our SDM Skills Course.

Shared-Decision Making FAQ

Why should I involve my patients in their health care decisions?

Studies show that when making decisions after thoughtful, informed discussions between patients and their doctors, patients:

Feel more comfortable with their care decisions.
Better understand the care they receive.
Are more likely to stick to their care plan and have better health outcomes.
Have greater confidence in their health care team.

Knowing that you've closely tied your care plan to who your patient is and what they value can be professionally and personally satisfying to you as a clinician.

Why was the Beckwith Center for Shared-Decision Making created?

The Beckwith Institute developed the center to establish UPMC as a national leader in patient-centered care.

UPMC is part of a national collaborative among others like Dartmouth, Mayo Clinic, and Massachusetts General Hospital.

Where can I find research that supports SDM?

Shared-Decision Making: A Model for Clinical Practice.
Designing SDM Interventions for Dissemination and Sustainment. Can Implementation Science Help Translate SDM Into Routine Practice?
Association of SDM on Patient-reported Health Outcomes and Healthcare Utilizatio n.

Who can I contact with additional questions?

Email us at DecisionMaking@upmc.edu.