When Physicians and Patients Share Decision-Making

Assessing and measuring implementation of shared decision-making in accountable care organizations

Dates of Project: July 2011 through January 2014

Description: National Committee on Quality Assurance (NCQA) researchers developed a framework for understanding the structures, processes, and steps required for implementation of shared decision-making based on review of evidence and existing models.

They also conducted interviews with providers, administrators, and clinical staff; commissioned patient focus groups; and prepared case studies of six sites with established shared decision-making programs—three with breast cancer programs and three with prostate cancer programs.

“Shared decision-making is a teaching tool for everybody in the care team about what’s expected of the patient—that the patient participates, takes notes, asks questions, and that these questions are part of what’s presented to the doctor or the care team.”—Project Director Sarah Hudson Scholle, DrPH, MPH

Key Findings

  • Shared decision-making involves providing evidence-based information to the patient, taking into account patient preferences and values, coordinating patient care, following up with the patient, and documenting the process and the patient’s decision.

  • Sites implement shared decision-making in order to provide patient-centered care, achieve better outcomes, reduce physician time, improve patient satisfaction, and support their own team practice environment.

  • The need for emotional support was a key theme unique to conversations with patients and not evident in provider conversations. Patients expressed the desire to receive empathy from their physician and other care team members as well as for counseling beginning at diagnosis and through decision-making and treatment. They also found it important to have unbiased, evidence-based information to help them feel empowered and in control of the decision-making process.

“Focus both on having the right information to give to patients and on making the space and the time for the interaction that patients need that will address their emotional support needs. It’s not just the tools.”—Project Director Sarah Hudson Scholle, DrPH, MPH

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NCQA researchers find emotional support - plus info - is important to patients making treatment decisions.