Shared decision-making empowers patients and brings efficiency to the system

Shared decision-making is an essential tool for achieving patient empowerment and makes the healthcare system more efficient. This is the main conclusion of the conference held this Thursday at Parc Sanitari Sant Joan de Déu, in Sant Boi.

Dr Sebastià Santaeugènia, manager of the PSSJD, said that applying shared decision-making is “revolutionary” and, quoting Dr Víctor Montori, explained that this practice “is not just a clinical technique, it is an act of resistance against the dehumanisation of medicine”. Santaeugènia opened the conference with these comments.

During the event, the IMA-cRCT study was unveiled, which evaluates the impact and implementation process of shared decision-making, focusing on cardiovascular pathology and diabetes in primary care. The research, led by Dr Maria Rubio-Valera, from Parc Sanitari Sant Joan de Déu and the Sant Joan de Déu Research Institute, with the assistance of the ICS, is the starting point for this practice to be applied throughout Catalonia.

The data on which the research is based shows that up to 13% of people with these pathologies do not start treatment and up to 60% of those who do start abandon it prematurely. These figures imply high healthcare costs, less control over disease and losses in productivity. To reverse these trends, it is essential to bring about a paradigm shift and promote patient involvement in decision-making.

IMA-cRCT is aimed at adults who need a new treatment and uses professional training and shared decision-making support tools to help them decide. The results show that, although the application of IMA-cRCT does not affect medication adherence, it does reduce blood pressure and is highly efficient in people with cardiovascular disease and diabetes. Qualitatively, it should be noted that patients see it as a positive experience, feel better informed and consider themselves involved in decisions about their health, while the professionals who took part in the study report an improvement in their relationship with the patient.

Shared decision-making “can help the person receiving the diagnosis to cope better with the situation,” said Maria Rubio-Valera. It is a process in which professionals and patients collaborate to choose the best option for dealing with illness. First, it is necessary to identify what needs to be decided, ensure the patient is fully informed and propose possible alternatives to the treatment, if the patient's case allows this. The pros and cons of the different options that the patient can choose need to be discussed and analysed, so that a decision can finally be made. Once implemented, this must be reviewed periodically to assess the results and, if necessary, alternatives must be sought.

An essential part of the event was the participation of Txema Navarro, an experienced patient who spoke about the improvement that being able to choose which treatment to receive has meant for his condition. Navarro respects the choice of some patients who do not want to be informed, but for those who, like him, do want to be informed, there must be a mechanism for them to receive reliable information.

Although there is a belief that consultation time is insufficient, explains Sara-Anna Davies, a specialist in Family and Community Medicine with the Catalan Health Institute, studies like the IMA-cRCT study show that this is not the case. Davies suggests that it is better not to pack everything into a single visit, and that it is in successive visits that possible doubts can be resolved and decisions made. She also believes it is necessary to dedicate time to training, so that both professionals and patients understand what shared decision-making is.

It is important to know the population you are targeting, according to Dr Miguel Ángel Robles, clinical nurse and Nursing Coordinator of the Multiple Sclerosis Centre of Catalonia (CEMCAT) at the Vall d'Hebron Hospital in Barcelona. In his service, Robles deals with a "literate, young, highly technological population that asks itself questions like what we mean when we talk about effectiveness". He therefore proposes improving the digital tools that help in shared decision-making.

Montse Moharra, Shared Decision Making Project Leader and Secretary of Healthcare and Participation with the Government of Catalonia's Ministry of Health, confirmed that the Government is promoting different measures to break down patients' resistance and empower them.

If shared decision-making is complex with adults, it is even more so with geriatric and paediatric patients. "In order to target this sector, we must first mature what we are doing now," Moharra commented. For Robles, one of the challenges is also shared decision-making among the constantly increasing number of older people who are ageing alone.

The day ended with a shared challenge: "we must move away from a paternalism that has been within the system for many years," concluded Marga Garcia Canela, head of the Catalan Institute of Health Citizen Service.