Physician-Patient Communication

Shared Decision Making (continued)

Research has revealed that patients of physicians who use participatory decision-making are more satisfied with their care and have better health outcomes.  So do patients who actively seek out medical information, ask questions and express their opinions. (10)  

The “tools” needed for shared decision-making include knowing the patient, providing complete information, individualizing one's style, handling disagreement, and guiding patients to more information. (9)  Familiarity with a patient’s values and goals, as well as his/her fears, can help the physician to guide a patient toward the appropriate medical decision.  At the same time, providing complete information and fully informing a patient about a disease is imperative.  Even people who do not want to participate in making medical decisions often appreciate any information relevant to their medical condition.  

In addition to providing information, the physician must be flexible in his or her approach to imparting information.  Different patients will have different levels of medical understanding, of interest, and of ability to participate in decision-making.  The desire for information tends to be lower among elderly patients, those younger than 30, and those with less education. (10)

Directing patients to appropriate sources of information, such as a credible website on the Internet (e.g., the American Cancer Society), can be helpful and reassuring. (10)  This is best accomplished after the physician has determined the patient's values, goals and fears, as well as the patient’s health literacy.

A potential barrier to shared medical decision making is disagreement between physician and patient.  Determining the source of the disagreement can help direct the course of action.  A patient may refuse a treatment because he or she thinks it would be useless; on the other hand, the patient may simply be afraid of side effects and need reassurance that a treatment is safe.  Sometimes, arranging for a second opinion can facilitate resolution of disagreements.

In some cases, cultural differences impede doctor-patient communication.  Shared decision making requires exploring this possibility and tailoring the conversation to address cultural values as well as physical, psychological, and informational needs.  “Culture” can include religious, ethnic, and even regional heritage.  There may be great diversity within these groupings.  Interpretations of values may differ from person to person even if their cultural heritage is shared.

If a patient’s capacity to make a decision is impaired, further evaluation of the patient’s competence may be warranted, especially in potentially life-threatening situations.

Shared Decision Making and Colorectal Cancer Screening

An important part of shared decision making is informing the patient about possible advantages, disadvantages, risks and benefits of a given test or treatment.  The checklist in Table 5 may help you and your patients differentiate the CRCscreening modalities and select the most appropriate one.