Shared decision making in primary care and health outcomes: an integrative review
DOI:
https://doi.org/10.5712/rbmfc16(43)2388Keywords:
Clinical Decision-Making, Primary Health Care, Patient Outcome Assessment, Outcome and Process Assessment, Health Care.Abstract
Introduction: The process of shared decision making can be defined through the following elements: 1. there are, at least, two persons involved in the decisional process, the doctor and the patient; 2. doctor and patient share information; 3. both contribute to the decisional processes exposing it’s preferences; 4. a decision upon which all agree is achieved. Its use is justified mainly by the ethical aspect of including the patient in the decisions whose consequences he will suffer. However, much is questioned about the relation between this practice and health outcomes. Objectives: This study aims to evaluate the relation between shared decision making and health outcomes in primary care settings. Methods: An integrative review of the literature was carried out. Articles that contained an empirical measure of shared decision during the clinical encounter, whose scenario was primary health care and that presented evaluation of at least one health outcome were included. Results: Ten articles were included in the study, and the topics covered are depression (4 articles), hypertension (2), diabetes (1), cardiovascular risk (1), colorectal cancer screening (1), and infertility (1). Half of the studies on depression found a positive association between shared decision making and improvement of depressive symptoms. None of the studies on hypertension detected statistically significant associations. The diabetes study found a positive correlation between shared decision making and reduced glycated hemoglobin and LDL. Sharing the decision when discussing cardiovascular risk did not worsen the score of this indicator after 6 months. Regarding colorectal cancer screening, discussing risks and benefits and assessing patient preferences was negatively associated with the performance of screening tests. Finally, shared decision making was associated with better care experience for people being monitored for infertility in primary care. Two studies timed consultations and found no time differences between those who used and those who did not use shared decision making. Four studies did not conceptually define shared decision making and four studies did not use validated tools to measure it. Conclusion: Regarding the specified outcomes, the articles included in this review show ambiguous results, with an apparent positive correlation trend between shared decisions and outcomes. However, the lack of uniformity regarding the conceptual definition of shared decision making seems to be a potential barrier for higher quality research in the area.
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(1) Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med. 1997 Mar;44(5):681-92. DOI: https://doi.org/10.1016/S0277-9536(96)00221-3
(2) Makoul G, Clayman ML. An integrative model of shared decision making in medical encounters. Patient Educ Couns. 2006 Mar;60(3):301-12. DOI: https://doi.org/10.1016/j.pec.2005.06.010
(3) Moumjid N, Gafni A, Brémond A, Carrère MO. Shared decision making in the medical encounter: Are we all talking about the same thing?. Med Decis Mak. 2007 Set;27(5):539-46. DOI: https://doi.org/10.1177/0272989X07306779
(4) Cribb A, Entwistle VA. Shared decision making: trade-offs between narrower and broader conceptions. Heal Expect. 2011;14(2):210-9. DOI: https://doi.org/10.1111/j.1369-7625.2011.00694.x
(5) Beauchamp TL. Methods and principles in biomedical ethics. J Med Ethics. 2003 Set;29(5):269-74. DOI: https://doi.org/10.1136/jme.29.5.269
(6) Conselho Federal de Medicina (CFM). Código de Ética Médica. Resolução CFM no 2.217, de 27 de setembro de 2018, modificada pelas Resoluções CFM no 2.222/2018 e 2.226/2019. Brasília (DF): CFM; 2019.
(7) Wennberg JE, Barnes BA, Zubkoff M. Professional uncertainty and the problem of supplier-induced demand. Soc Sci Med. 1982;16(7):811-24. DOI: https://doi.org/10.1016/0277-9536(82)90234-9
(8) Kasper JF, Mulley Junior AG, Wennberg JE. Developing shared decision making programs to improve the quality of health care. Qual Rev Bull. 1992 Jun;18(6):183-90. DOI: https://doi.org/10.1016/S0097-5990(16)30531-0
(9) McCormack J, Elwyn G. Shared decision is the only outcome that matters when it comes to evaluating evidence-based practice. BMJ Evidence-Based Med. 2018;23(4):137-9. DOI: https://doi.org/10.1136/bmjebm-2018-110922
(10) Stewart M, Brown JB, Weston WW, McWhinney IR, McWilliam CL, Freeman TR. Medicina centrada na pessoa, transformando o método clínico. 3rd ed. Porto Alegre: Artmed; 2017.
(11) Kurtz S, Silverman J, Benson J, Draper J. Marrying content and process in clinical method teaching. Acad Med. 2003 Ago;78(8):802-9. DOI: https://doi.org/10.1097/00001888-200308000-00011
(12) Härter M, Moumjid N, Cornuz J, Elwyn G, Van Der Weijden T. Shared decision making in 2017: international accomplishments in policy, research and implementation. Z Evid Fortbild Qual Gesundhwes. 2017 Jun;123:1-5. DOI: https://doi.org/10.1016/j.zefq.2017.05.024
(13) National Health Service (NHS). Equity and excellence: liberating the NHS. London, UK: NHS - Department of Health - The Stationery Office Limited; 2010.
(14) Australian Commission on Safety and Quality in Health Care (ACSQHC). National Safety and Quality Health Service Standards. 2nd ed. Sydney: ACSQHC; 2017.
(15) Ministério da Saúde (BR). Secretaria-Executiva. Núcleo Técnico da Política Nacional de Humanização. HumanizaSUS: Política Nacional de Humanização: a humanização como eixo norteador das práticas de atenção e gestão em todas as instâncias do SUS. Brasília (DF): Ministério da Saúde; 2004.
(16) Ministério da Saúde (BR). Portaria nº 2.436, de 21 de setembro de 2017. Aprova a Política Nacional de Atenção Básica, estabelecendo a revisão de diretrizes para a organização da Atenção Básica, no âmbito do Sistema Único de Saúde (SUS). Diário Oficial da União, Brasília (DF), 22 set 2017; Seção 1:68.
(17) Scholl I, Van Loon MK, Sepucha K, Elwyn G, Légaré F, Härter M, et al. Measurement of shared decision making - a review of instruments. Z Evid Fortbild Qual Gesundhwes. 2011;105(4):313-24. DOI: https://doi.org/10.1016/j.zefq.2011.04.012
(18) Katz SJ, Hawley S. The value of sharing treatment decision making with patients: expecting too much?. JAMA. 2013 Out;310(15):1559-60. DOI: https://doi.org/10.1001/jama.2013.278944
(19) Souza MT, Silva MD, Carvalho R. Revisão integrativa: o que é e como fazer Integrative review. Einstein. 2010 Jan/Mar;8(1):102-8.
(20) Sanders ARJ, Van Weeghel I, Vogelaar M, Verheul W, Pieters RHM, Wit NJ, et al. Effects of improved patient participation in primary care on health-related outcomes: a systematic review. Fam Pract. 2013 Ago;30(4):365-78. DOI: https://doi.org/10.1093/fampra/cmt014
(21) Johnson RA, Huntley A, Hughes RA, Cramer H, Turner KM, Perkins B, et al. Interventions to support shared decision making for hypertension: a systematic review of controlled studies. Heal Expect. 2018 Set;21(6):1191-207. DOI: https://doi.org/10.1111/hex.12826
(22) Cooper LA, Roter DL, Carson KA, Bone LR, Larson SM, Miller ER, et al. A randomized trial to improve patient-centered care and hypertension control in underserved primary care patients. J Gen Intern Med. 2011;26:1297-304. DOI: https://doi.org/10.1007/s11606-011-1794-6
(23) Tinsel I, Buchholz A, Vach W, Siegel A, Dürk T, Buchholz A, et al. Shared decision-making in antihypertensive therapy: a cluster randomised controlled trial. BMC Fam Pract. 2013 Set;14:135. DOI: https://doi.org/10.1186/1471-2296-14-135
(24) Krones T, Keller H, Sönnichsen A, Sadowski EM, Baum E, Wegscheider K, et al. Absolute cardiovascular disease risk and shared decision making in primary care: a randomized controlled trial. Ann Fam Med. 2008;6(3):218-27. DOI: https://doi.org/10.1370/afm.854
(25) Loh A, Leonhart R, Wills CE, Simon D, Härter M. The impact of patient participation on adherence and clinical outcome in primary care of depression. Patient Educ Couns. 2007 Jan;65(1):69-78. DOI: https://doi.org/10.1016/j.pec.2006.05.007
(26) Loh A, Simon D, Wills CE, Kriston L, Niebling W, Härter M. The effects of a shared decision-making intervention in primary care of depression: a cluster-randomized controlled trial. Patient Educ Couns. 2007 Ago;67(3):324-32. DOI: https://doi.org/10.1016/j.pec.2007.03.023
(27) Clever SL, Ford DE, Rubenstein LV, Rost KM, Meredith LS, Sherbourne CD, et al. Primary care patients’ involvement in decision-making is associated with improvement in depression. Med Care. 2006 Mai;44(5):398-405. DOI: https://doi.org/10.1097/01.mlr.0000208117.15531.da
(28) Ling BS, Trauth JM, Fine MJ, Mor MK, Resnick A, Braddock CH, et al. Informed decision-making and colorectal cancer screening: is it occurring in primary care?. Med Care. 2008 Set;46(9):S23-9. DOI: https://doi.org/10.1097/MLR.0b013e31817dc496
(29) Parchman ML, Zeber JE, Palmer RF. Participatory decision making, patient activation, medication adherence, and intermediate clinical outcomes in type 2 diabetes: a STARNet study. Ann Fam Med. 2010;8(5):410-7. DOI: https://doi.org/10.1370/afm.1161
(30) LeBlanc A, Herrin J, Williams MD, Inselman JW, Branda ME, Shah ND, et al. Shared decision making for antidepressants in primary care a cluster randomized trial. JAMA Intern Med. 2015 Nov;175(11):1761-70. DOI: https://doi.org/10.1001/jamainternmed.2015.5214
(31) Wilkes S, Hall N, Crosland A, Murdoch A, Rubin G. Patient experience of infertility management in primary care: an in-depth interview study. Fam Pract. 2009 Ago;26(4):309-16. DOI: https://doi.org/10.1093/fampra/cmp039
(32) World Health Organization (WHO). Mental health - Action plan 2013-2020. Genebra: WHO; 2013.
(33) Joosten EAG, DeFuentes-Merillas L, De Weert GH, Sensky T, Van Der Staak CPF, De Jong CAJ. Systematic review of the effects of shared decision-making on patient satisfaction, treatment adherence and health status. Psychother Psychosom. 2008;77:219-26. DOI: https://doi.org/10.1159/000126073
(34) Shay LA, Lafata JE. Where is the evidence? A systematic review of shared decision making and patient outcomes. BMC Med Decis Mak. 2015 Out;35(1):114-31. DOI: https://doi.org/10.1177/0272989X14551638
(35) Hughes TM, Merath K, Chen Q, Sun S, Palmer E, Idrees JJ, et al. Association of shared decision-making on patient-reported health outcomes and healthcare utilization. Am J Surg. 2018 Jul;216(1):7-12. DOI: https://doi.org/10.1016/j.amjsurg.2018.01.011
(36) Abreu MM, Mello JPS, Ribeiro LFF, Mussi LA, Borges MLL, Petroli M, et al. Shared decision making in brazil. Concrete efforts to empowering patient’s voice. Z Evid Fortbild Qual Gesundhwes. 2017 Jun;123:21-2. DOI: https://doi.org/10.1016/j.zefq.2017.05.022
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