Lead author of ‘Interventions for increasing the use of shared decision making by healthcare professionals’ discusses Cochrane Review

Lead author ‘Interventions for increasing the use of shared decision making by healthcare professionals’ discusses Cochrane Review

A Q&A with the lead author, France Légaré

Lead author, France Légaré, recently published the Cochrane Effective Practice and Organisation of Care review ‘Interventions for increasing the use of shared decision making by healthcare professionals’ in the Cochrane Library. Shared decision making is a promising approach for preference-sensitive decisions for example initiating hormone replacement therapy for menopausal symptoms or choosing to undergo surgery for knee osteoarthritis. It helps patients and families identify the best options, clarify their values and preferences, and have effective conversations with their healthcare professional thus allowing them to have better control over their treatment plans. However, more work needs to be done to know what are the most promising strategies to put shared decision making into practice.

Please can you describe yourself and your Cochrane Group?

Since 2006 I have held a Canada Research Chair in Shared Decision Making and Knowledge Translation. Our research programme's overarching goal is to provide health professionals and their patients with the necessary skills to promote shared decision-making throughout the healthcare continuum.

With this goal in mind, we partnered with experts in shared decision making and patient decision aids around the world to identify the most promising strategies to put shared decision making into practice and thus ensure that patients and families have better control over their treatment plans

What was the background to the Review? 

In 2006, the Canada Research Chair in Shared Decision Making and Knowledge Translation team published the first systematic review on barriers and facilitators to implementing shared decision making into practice but then we realised we needed to identify the most promising strategies to put shared decision making into practice that would address these barriers and facilitators.

Why was it important to conduct this Review?

This review is important because: a) patient involvement in decisions about their health is accepted as a right; b) patients in general want more information about their health condition and prefer to take an active role in decisions about their health; c) shared decision making may reduce the overuse of options not clearly associated with benefits for all and increase the use of options clearly associated with benefits for the vast majority of the concerned population; d) shared decision making may reduce unwarranted healthcare practice variations; and e) shared decision making may foster the sustainability of the healthcare system by increasing patient ownership of their own healthcare. Yet in spite of these benefits we can have little confidence as yet in the effectiveness of various methods that have been tried for increasing the use of shared decision by healthcare professionals.

What are the main implications of this research?

There are several gaps in knowledge about the effectiveness of interventions focused on increasing shared decision making among healthcare professionals.

Future studies should:

  • be designed to minimize bias regarding risk of contamination and should have enough power to estimate the effects of active interventions on increased use of shared decision making among healthcare professionals (primary outcome).
  • report their methods and results in enough detail and according to the recommended reporting guidelines to allow extensive assessment of risk of bias.
  • develop better patient-derived measures of shared decision making. Improved methods for measurements might produce consistency between observer-based and patient-reported measures of shared decision making.
  • assess the same intervention across multiple clinical contexts, health professionals and also across diverse jurisdictions (i.e. international collaborations).
  • more clearly determine the cost of interventions to increase the use of shared decision making and the impact of different clinical care payment mechanisms on the use of shared decision making.

What would you like to see happen as a result of publishing this review?  

Better research! And better reporting of research!

Friday, July 20, 2018
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