Breaking Down the Essential Elements of Shared Decision-Making

The National Eczema Association (NEA) research team has published its latest paper on shared decision-making (SDM), or the process through which patients and/or caregivers and health care providers (HCPs) work together to make informed decisions about treatments and/or care plans.

This new research, published in the Journal of the American Academy of Dermatology International, is the second publication from the survey NEA conducted in early 2021 of its patient and caregiver community regarding their experiences, preferences, and motivators for SDM.

The survey encompassed several factors related to SDM, asking 840 respondents to rate each on a scale of 0 (not important at all) to 4 (absolutely essential), as well as how often these factors were true with their current eczema HCP.¹ Factors included aspects about the HCP, the patient, the visit, and the guidance provided.

Respondents were considered to have their “needs met” if they indicated a factor was very important or absolutely essential and also reported it as usually or always true. For the 9 factors deemed very important/absolutely essential by at least 80% of respondents, the percentage of respondents who indicated their needs were not met ranged from 11.4% to 36.3%.¹

Overall, the study revealed that eczema patients and caregivers want to be involved in decision-making for their treatments and SDM is more likely to be facilitated when patient education and empowerment are combined with HCPs who initiate treatment discussions and are compassionate listeners to patient perspectives.

Aspects About the Provider

Eczema patients and caregivers overwhelmingly prioritized HCPs who elicit trust, listen to their perspectives, and value their input to feel comfortable engaging in SDM. Trust in a HCP has been shown to increase treatment adherence, and strong patient-HCP relationships can decrease potentially costly communication errors.^2–7 A recent study of over 38,000 reviews of general dermatology clinics concluded that a HCP’s personality, empathy, and kindness may help overcome other issues that are out of their control.⁸

Although the current study showed few eczema patients perceived that the race, ethnicity, and gender of their HCP matching their own was important for SDM, as many as half of all Black respondents did identify this as a key factor for race and ethnicity.¹

Aspects About the Patient

Patients and caregivers in this study also acknowledged their own health literacy as an important factor and did not feel that the responsibility for the facilitation of SDM was solely on the HCP. Approximately 92% of respondents said that their own health literacy, the ability to articulate their experience and feeling comfortable enough to do so, was very important or absolutely essential for facilitating SDM. About 88% of respondents felt that these factors were usually or always true for them with their current eczema HCP.¹

Aspects About the Visit and Guidance

In this study, over 85% of patients reported it was important to not feel rushed during their appointment and, yet, around one-third said this was an unmet need with their current HCP.¹ Previous studies have shown that SDM in a dermatology encounter can effectively occur before, during, or after a visit and can take as little as 2 to 5 minutes without adding overall time to the time already spent in routine discussions of treatment.^9–13 This study also showed that 42.4% of patients did not find in-person visits to be important for SDM.¹ This may suggest the possibility for more patients and HCPs to utilize virtual visits when applicable.

Additionally, of the eczema patients and caregivers who reported that having a HCP initiate the discussion about treatment options is important/essential to them, 39% reported an unmet need with their current HCP. Patients who feel equipped to discuss treatment options with a doctor they trust may additionally require an opening from the HCP to start the conversation.

Key Takeaways

A chronic condition like eczema requires dynamic SDM, which may involve several treatment decisions over time. Ideally, SDM results from an ongoing dialogue over many visits between a trusted HCP and a patient or caregiver who has health literacy and the tools to advocate for themselves. This study indicated that successful SDM is more likely to be facilitated when efforts to improve patient education and empowerment are coupled with HCPs who initiate treatment discussions, maintain compassion resilience, and value patient perspectives.¹

Lauren Hewett is the director of marketing for NEA.

This article is reprinted with permission from https://national eczema.org/blog/new-nea-research-breaking-down-the-essentialelements-of-shared-decision-making

References:

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