From: Implementing shared decision-making: consider all the consequences
Accomplishing collaborative deliberation | Proximal effects | Distal effects | Distant effects |
---|---|---|---|
Informed preference; cognitive and affective effects | Cautious decisions; modified relationships; enduring trends | Modified utilization and resource use; modified help seeking behavior | |
Individual levels | Preferences for outcomes and treatments based on comprehension of high-quality evidence. | Collaborative deliberation generates different clinician-patient and patient-care team relationships—with positive and negative potential. | Increased use of interventions that lower risk of harms, raise likelihood of benefits. |
Lower utilization of high-risk, marginal-benefit interventions. | |||
Potential conflict where informed patient preference is not supported by clinician or organizational policies. | |||
Improved adherence to selected options and less regret about choices made, improved resilience and self-efficacy. | |||
Greater engagement in assessing the long-term value of interventions, leading to lower service utilization and improved self-management by patients. | |||
Realistic expectations with possible changes in confidence and satisfaction levels. | |||
Clinicians experience the synergy of working to aligned organizational-based incentives. | |||
Potential for reduced risk of professional burnout. | |||
Reduced intention to choose intensive treatment in some settings. | |||
Clinicians experience intrinsic reward for work done well. | |||
Clinicians experience the cognitive and emotional work of supporting patients making decisions. | |||
Interactional and group levels | Enhanced relationships with clinicians and with clinical teams | Development of team culture that generates realistic expectations and judicious use of resources | Norms established: collaboration and deliberation become expected behaviors |
Dissatisfaction due to decisional burden, decisional conflict, uncertainty, and concern about honoring patient preferences. | |||
Patients prompted to ask questions, assess the value of interventions | |||
Enhanced relationships reduce complaints and legal challenges. | |||
Exhibiting respect for individuals’ informed preferences leads to increased satisfaction with care, at dyadic and group levels. | |||
Organizational levels | Many clinicians in an organization become willing to share information, with patients, about alternative options. | Higher aggregate patient experience scores, e.g., satisfaction with care | Change in resource utilization requires workforce changes. |
Different utilization patterns lead to changes in delivery infrastructure and capacity. | |||
Higher scores on organizational measures of patient-centered care. | |||
Organizational commitment to resource, promote, and sustain collaborative deliberation. | |||
Fewer legal challenges. | |||
Improved staff morale, lower incidence of professional burnout, and less absenteeism. | |||
Redesign of workflow, space, and information systems will short term require investment. | |||
Healthcare system level | Collaborative deliberation viewed as normative, therefore embedded in policies, systems, and rewards. | Greater skepticism and scrutiny of new drugs, interventions, and services. | Lower resource utilization, with trends to more cost-effective care, that leads to changes in strategic investment decisions. |
Improved cost-effectiveness. | System level interest population health, and its determinants. | ||
Recruits learn and follow different policies. | |||
Reduction in malpractice costs. |