Systems to support shared decision-making (Shared Decision Making – SDM) between patients and doctors are becoming increasingly important, especially in Anglo-Saxon countries. Let’s see what they are and how they work.
Shared Decision Making (SDM) is a practice that involves patients and their treating physicians in making treatment choices together; they consider current evidence, discuss the potential benefits and risks of each option, allowing the patients to make an informed choice about the next step of their treatment.
SDM aids are clinical tools that a patient and his doctor can use to facilitate this type of discussion: videos, handouts, applications and web resources.
The National Institute for Health and Care Excellence – NICE hosts a list of tools for sharing decisions with patients on its website.
Ottawa Hospital Research Institute (OHRI) has an SDM resource site, organized alphabetically by health problem, which is very rich in content.
Mayo Clinic has created a Shared Decision-Making Resource Center that contains tools for the:
- Choice for primary cardiovascular prevention
- Choice of diabetes medications
- Choices for osteoporosis
- Choice of medication for depression
- PCI Choice
- Smoking cessation during surgery
For each area there are risk calculators, interactive tools and videos or other inherent material available.
For example, the interactive tool for cardiovascular prevention choices requires you to set the risk factors (with three modes: ACC/AHA; Framingham; Reynolds) and indicate any ongoing therapies (statins). When these values are entered, the tool shows the risk level on the left and the possible alternatives on the right, if any.
HealthDecision, a company recently acquired by EBSCO, develops SDM tools based on Evidence Based Medicine. On this page you can try one of its tools on atrial fibrillation, cardiovascular risk, osteoporosis, breast or lung cancer screening, hypertension. The tool on cardiovascular risk is similar to that of the Mayo Clinic, with the difference that the tool highlights the impact of the decision and, for each treatment choice, the possible side effects.
Besides, on cardiovascular risk Therapeutics Education Collaboration has published an online, interactive calculator that provides an absolute estimate (%) of a person’s chance of having a cardiovascular event over a given period of time and an idea of the potential benefit of specific treatments.
SPARCTool is an online calculator developed by Peter Loewen for estimating stroke risk and the benefits and risks of antithrombotic therapy in patients with chronic atrial fibrillation, incorporates CHADS2/CHA2DS2-VASc and HAS-BLED and shows statistics on the efficacy/risk of old and new anticoagulants.