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.
Meeting of worlds doctor and patient
According to Driever, two worlds come together in the process of joint decision-making. ‘The world of the patient with his knowledge, wishes and needs, 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. Driever examined almost 800 videotaped consultations of 41 medical specialists with their patients in 18 different departments. Pediatrician and professor of clinical education Paul Brand was her supervisor.
The best treatment
Driever’s research shows that doctors discussed several treatment options with their patients and that they then make a proposal for one 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 Driever, 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. Driever: ‘To really arrive at a treatment that best suits the individual patient, it is important to discuss the patient’s wishes and preferences. And, 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 experienced now.
second nature
According to Driever, this research has provided more insight into the way doctors think and work when it comes to making decisions together. Driever: ‘My research has made 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.’
By: National Care Guide