Since 2012, Massachusetts General Hospital in Boston has used shared decisionmaking tools to help patients understand if elective orthopedic surgeries are right for them.
The tools, and the conversation they ignite, fosters patient trust with providers, said Karen Sepucha, director of the Health Decision Sciences Center at Massachusetts General.
To establish trust, “patients want to feel heard and they want to make sure they are getting good information and those are things shared decisionmaking can help with,” she said.
The tool is a booklet that outlines the condition and then the different options—both surgical and non-surgical—the patient has. It details the benefits such as the outcomes associated with the surgery but also the risks including the likelihood for complications. Questions at the end of the booklet are used to gauge how well the patient understood the information as well as their personal preferences.
In some cases, physicians can review the patient’s responses before the visit if they filled it out online using the patient portal. If not, they review the responses with the patient during the appointment.
The clinical team has been trained on how to have a conversation with the patient that communicates risks without confusing them, how to gather from the patient their goals and preferences and to understand when it’s best to make a recommendation or leave the decision up to the patient.
One thing the tool doesn’t address is the patient’s expected out-of-pocket costs, which is a huge gap, said Chris Duke, director of the Center for Consumer Choice in Health Care at consultancy Altarum.
“A part of shared decisionmaking is knowing how much something will cost and agreeing to it. Maybe someone doesn’t want that treatment if it’s going to bankrupt them,” he said.
Sepucha agreed that it’s “certainly an area in need of more attention and tools.”
Despite literature showing shared decisionmaking improves patient trust and satisfaction, the concept hasn’t been widely adopted across the industry, she said. The current payment system is a big reason why. Often, shared decisionmaking encourages the patient to go the less-invasive route, which means fewer services are necessary.
“This will save money if you are the insurer but if you are the doctor, it’s going to cost you,” she said.
Since they’re working at a leading academic medical center, Massachusetts General doctors don’t have to worry about lack of demand for their services, “but that’s not the case for everybody,” Sepucha said.