Shared decision making in hospital care: what happens in practice

Shared decision making (SDM) is presented by the government, and by patient and healthcare organizations, as the preferred model of decision making in medical consultations. SDM can improve therapy adherence and patient outcomes. SDM allows the physician’s medical expertise to be coupled to the patient’s unique situation, views and preferences.

Most healthcare providers and patients want to make decisions about diagnostics and treatment together with each other. This thesis examines how doctors think about SDM, and how they apply it in daily clinical practice.

We videotaped 781 consultations between hospital-based consultants and their patients, and analyzed the decision-making process. In these consultations, doctors applied less SDM than they prefer and they thought they did. They presented different options, then made a proposal and asked the patient to consent with this treatment. However, they skipped a key SDM step: choice awareness. Making it clear that a choice has to be made, and that the physician and patient decide together, as a team, which option best fits the patient’s current situation.

Our studies show that doctors need to be made aware of their own decision-making behavior, as they do not apply as much SDM as they think they do. In addition, skills training is required to support doctors to apply all SDM steps. In this dissertation, we propose an SDM training model to promote that doctors make decisions with their patients instead of for their patients.