Shared Decision Making
Shared Decision Making (SDM) is a collaborative process in which doctors and patients work together to select tests, treatments and Chiropractic Care management, based on clinical evidence, patient values and their subsequent informed consent. SDM explicitly acknowledges the fact that there is usually more than one way to approach a Musculo-Skeletal (MSK) problem. People may require guidance in weigh up the benefits and harms of their options, in order to determine their best choice.
There is good evidence that SDM benefits patients, improving the quality and appropriateness of clinical decision making. A Cochrane Review of 115 randomised control trials found that use of patient decision aids leads to improved outcomes for those people interested in shared decision making. This might include a decision to have an x-ray or MR referral based upon the persons psychological desire to ‘see’ their back or neck. The decision is not all about patient demands as the law needs to be complied with and statutes are often applicable.
It is also an effective strategy for tackling overdiagnosis and overtreatment. For example, interventions to promote SDM, have been shown to lead to reductions in unhelpful MSK management strategies because the patient could not grasp the expertise of the Chiropractor in feeling their condition, rather than seeing their condition with for example an x-ray.
A fundamental aim of Choosing Wisely UK is to use shared decision making to reduce unnecessary tests, treatments and time to recovery.
Five Questions to Ask my Doctor, Nurse or Chiropractor, To Make Better Decisions Together.
1. Do I really need this test and or treatment course?
2. What are the possible side effects of the treatment proposed?
3. What are the possible side effects?
4. Are there simpler safer options?
5. What will likely happen if I do nothing?