Physicians are increasingly being asked to make decisions about research or treatment together with their patients. Joint decision-making is inextricably linked to the care of the future, in which sensible care in consultation with the patient becomes the guiding principle. Equally important is the gain that can be achieved through joint decision-making when it comes to therapy compliance and patient outcomes. Isala doctor and UMCG PhD candidate Ellen Driever conducted research into the way in which doctors do this.
According to Ellen, in the process of joint decision-making, two worlds come together. ‘The world of the patient with his knowledge, wishes, preferences and beliefs and the world of the doctor with knowledge and experience about diseases and about possible investigations or treatments.’ To gain more insight into how these worlds come together, she researched both the world of medical specialists and that of patients in Isala. Her most important question: why is it so difficult to make decisions together in practice, even though the will is there? More than 400 medical specialists and physician assistants from Isala participated in the study. Ellen examined nearly 800 videotaped consultations of 41 medical specialists with their patients. These consultations took place in 18 different departments. Pediatrician and Isala Academy Dean Paul Brand was her supervisor.
The best treatment
Ellen’s research shows that doctors discussed several treatment options with their patients and that they then propose a specific treatment. The proposed treatment is the one that is medically preferred and most appropriate for the patient’s diagnosis. The idea that the patient deserves the best medical treatment plays a decisive role in the final choice.
Need more steps
According to Ellen, doctors do intend to decide together. By naming the treatment options with their pros and cons, an important step has been taken in making joint decisions. But there are still more steps to take within deciding together. Ellen: ‘To really arrive at a treatment that best suits the patient, it is important to discuss the patient’s wishes and preferences. In order for that process to run smoothly, it is necessary to explain earlier in the conversation that the doctor will work together with the patient to arrive at the most appropriate decision.’ Her research made it clear that these two steps are still often missing.
In the study, all patients were also asked how they experienced the decision-making process with their doctor about treatment. Although patients were generally very satisfied with the consultation, it also appeared that they wanted to be even more involved in the decision-making than they were experiencing now.
second nature
According to Ellen, her research provides more insight into the thinking and working methods of doctors when it comes to joint decision-making. Ellen: ‘My research has made it clear what a learning path for doctors in joint decision-making should be aimed at: awareness and training. Awareness of the difference between the current conversation and decision-making together. And training to improve the ability to decide together. Conscious practice and reflection using video images is a good way to make joint decision-making second nature. I hope that this research will inspire healthcare providers to make decisions with their patients instead of for their patients.’
The Isala Academy processes the insights from the PhD research in the training courses of medical specialists and residents.