American Society of Regional Anesthesia and Pain Medicine May 2017 - 16
Figure 1: The SHARE Approach to shared decision-making. Reprinted from Agency for Healthcare Research and Quality, 2016.12
THE CONCEPT OF SHARED DECISION-MAKING
Shared Decision-Making is the model of including patients and
their family in the decision-making process (Figure 1). The Agency
for Healthcare Research and Quality has published the "SHARE"
Approach to this type of process, which includes the following
five steps: (1) Seek your patient's participation, (2) Help your
patient explore and compare treatment options, (3) Assess your
patient's values and preferences, (4) Reach a decision with your
patient, and (5) Evaluate your patient's decision.12 The conventional
informed consent discussion typically includes a description of
the treatment. However, a full explanation of alternatives and an
assessment of how this treatment choice fits within the patient's
values and preferences are often lacking. According to Posner et
al,13 70% of the informed consent litigation complaints revolve
around the risks of treatment. To avoid the pitfalls of using incorrect
data, using terms not comprehensible to patients, and avoiding
the dissatisfaction that patients express is associated with the
paternalistic approach to the consent processes, providers may
choose to rely more on the SHARE principles for consent and
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consider the creation and use of decisions aids.14 This would allow
the patient and family, who may have strong beliefs and views, to
communicate with the physicians about their medical management
and for both to come together to craft a unique and specific plan: a
true ideal of patient-centered care.
Shared decision-making has become popular within many
specialties across medicine.15-19 These discussions are now
starting to populate the field of anesthesia and chronic pain.20 One
impact of this process is improved patient satisfaction. Flierler et
al14 showed that 94% of patients wanted to be involved in their
anesthetic decision-making and that to be involved increased
patient satisfaction. Hwang et al21 similarly demonstrated that 88%
of patients wanted to be involved in their choice of anesthetic,
resulting in patients feeling satisfied and respected.
The field of regional anesthesia is rapidly growing and can help
serve as the face of this movement toward patient education
and shared decision-making, owing to the frequent existence of
American Society of Regional Anesthesia and Pain Medicine
2017
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