Shared decision making and evidence-based practice

Evidence-based practice (EBP) recognises that patient values, preferences, and circumstances must be considered to increase the likelihood that we will do more good than harm. The challenge for clinicians can be in translating and applying (discussing with the patient) the pertinent evidence relating to options and their benefits and harms to engage patients in jointly making decisions that attend to the individual patient situation.

Hoffman and Glasziou suggest that, “Authentic evidence-based practice cannot occur if clinical decisions are made without consideration of the patient’s preferences, values, and circumstances or if patients are not, at least, invited to participate in making decisions”. [6] Benefits of shared decision making may include increased patient’s knowledge and understanding of risks; better clinician and patient communication; improved patient compliance; and a reduction in variations in practice, inappropriate use of drugs, tests, and treatments.

Various decision support tools now exist including decision aids, educational materials, instructional pamphlets, decision or fact boxes, videos, risk calculators, option grids, question prompt lists, evidence summaries, and communication frameworks.

The following provide decision aids and resources for some common conditions:

• Australian Commission on Safety and Quality in Health Care.
  https://www.safetyandquality.gov.au/our-work/shared-decision-making/patient-decision-aids/
• The Mayo Clinic’s Shared Decision Making National Resource Centre
  http://shareddecisions.mayoclinic.org/
• Decision Aid Library Inventory (DALI). The Ottawa Hospital Research Institute.
  https://decisionaid.ohri.ca/index.html
• Dartmouth-Hitchcock Centre for Shared Decision Making.
  http://med.dartmouth-hitchcock.org/csdm_toolkits.html
• International Patient Decision Aid Standards (IPDAS) Collaboration
  http://ipdas.ohri.ca/