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 valid 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 to realise that because their current Chiropractor is different to their previous Chiropractor it doesn’t mean that they must decide which Chiropractor is wrong in their approach.
There is good evidence that SDM benefits patients, improving the quality and appropriateness of clinical decision making. A Cochrane Review of 115 randomised controlled trials found that the 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 MRI referral based upon the persons psychological desire to ‘see’ their back or neck. A clinical decision is not only about patient demands.
It is also an effective strategy for tackling over-treatment. For example, interventions to promote SDM, have been shown to lead to reductions in unhelpful MSK management strategies. Unhelpful because the patient could not grasp the expertise of the Chiropractor in feeling their condition with their hands, rather than seeing their condition on 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?