Australia creates a groundswell of support for shared decision making in health care

A rapidly growing groundswell of public opinion in Australia is pushing strongly for a much stricter system to ensure that health care decisions are made more cooperatively between the patient and the health care provider.

This is the firm view of Professor France Légaré, from Laval University, Canada – a prominent international figure in the promotion of shared decision making in health care – that patients are leading the campaign and a structure is needed to ensure that doctors, nurses and health workers are also brought on board.

"In some states in the US, there has already been legislation introduced to force health care professionals to involve their patients in decisions about their diagnosis and treatment," said Professor Légaré.

"There are other options to legislation, but however it is achieved, health care professionals need to be brought to understand and participate in the practice of involving patients more closely in decisions-making about their health."

Professor Légaré was in Australia recently talking about shared decision making at a public lecture in Sydney and a symposium on shared decision making in Australia held at Bond University on the Gold Coast.

The Gold Coast Symposium was organised by Associate Professor Tammy Hoffmann and Professor Chris Del Mar from Bond University's Centre for Research in Evidence-Based Practice (CREBP), in conjunction with the National Health and Medical Research Council of Australia and the Australian Commission on Safety and Quality in Healthcare.

Shared decision making is the process where patients and clinicians work in partnership to integrate the patient’s values, goals and concerns with the best available evidence about benefits, risks and uncertainties of treatment, to make appropriate health care decisions.

At present Australia does not have a coordinated national approach to shared decision making.

Professor Légaré said there was a growing body of evidence showing shared decision making practices contributed to improved patient satisfaction and adherence to treatment plans, and helped to reduce unwarranted variation in clinical practice.

"There is a need for greater government policy making support for the whole idea of shared decision making, not only in Australia but in most other parts of the world," she said.

"But the view of health consumers as to what is good health care is growing exponentially in most of the industrialised world. 

"What we are now seeing is patients becoming more activated to sharing the making of decisions about their health and we need to get health care providers and staff to understand this process and to meet them half way."

"As we get more activated patients to voice what they want, we will see more health care providers sharing in this process and the result will be better outcomes for patients."

Professor Légaré – a GP by training – said when she started practice in Canada 23 years ago, doctors were actually taught to help their patients to accept the health care advice they were given.

"By the mid-1990s, we were starting to understand that we could achieve better results and better acceptance of medical advice if we involved the patients in making decisions.

"In some circumstances, shared decision making doesn't necessarily change the diagnosis or the treatment that may have been identified otherwise but it usually results in a better understanding by the patient of what needs to be done and why. However, evidence shows that in circumstances for which a less risky treatment option is available, shared decision making can lead patients and their providers to be more likely to choose this less risky option.

"A middle-aged woman who is going through menopause may still be at risk of fracturing a hip or a vertebra, but if she has been involved in the decisions about the treatment, she is more likely to understand the risks and less likely to do things which might result in an accident of this sort.

"She will have been given information about the best evidence-based research relevant to her treatment and hopefully have a better understanding of her own condition and the treatment required."

Professor Légaré stressed that a move towards shared decision making did not mean that doctors would be relieved of the responsibility of advising their patients about their health care.

"One of the essential elements of shared decision making is for the health provider to make a recommendation," she said. "Involving the patient in health care decisions does not remove the obligation for the provider to recommend what he believes is the best option.

"However, by sharing the decision making with the patient, the provider will often find out what is unique about a patient and discover information about the individual which may be important in deciding on forms of treatment."

Professor Légaré said the symposium at Bond University would have important ramifications for the development of shared decision making in Australia and highlighted the great expertise already taken place in the Centre for Research in Evidence-Based Practice research group.

"This symposium has brought researchers together with consumers or patients' representatives, government organisations and health care professionals to talk about this topic and the need to promote share decision making," she said.

"As a result of this meeting, a paper will be produced identifying research priorities and the next steps that need to be taken in Australia.

"In addition to that, the next international shared decision making conference will be held in Sydney in 2015 and there will be a strong presence there to highlight the importance of making sure people have access to the best evidence-based information and research available to enable them to share in the decision making process."