Putting patients at the heart of healthcare is increasingly critical as the evolving U.S. system shifts toward a new way of working. Within this, a key focus is on shared decision making (SDM) to help drive the process.
SDM offers patients a way in which to communicate their values and needs to their doctors to help build care plans that better fit into their lives. But how can this process be fostered to ensure it is a part of everyday practice?
Joanne Buzaglo, Senior Vice President, Research and Training at the Cancer Support Community (CSC), knows just how important SDM can be having first been diagnosed with cancer in 1988 and then again in 2013.
However, Joanne highlighted at a recent breakfast meeting at the American Society of Clinical Oncology (ASCO) annual meeting, there are many barriers that still exist that prevent SDM from becoming normal practice.
Building an agenda
“During the time between my two cancers, there were dramatic advances in both diagnostics and treatments,” says Joanne. “However, communication with my doctor felt virtually the same. I wasn’t asked about my values and goals or what was going on in my life.”
How was it so many advances could be made in care but so little in how patients communicated with their doctors? “In many ways,” Joanne explains, “having new immunotherapies, new diagnostics, new therapies present a greater challenge for shared decision making because it’s harder for doctors to explain the many treatment options and for patients to advocate for themselves and their needs in an effective way.”
With the help of a grant received in 2008, CSC has developed a support model to promote both clinical trials and SDM. “In the past, at CSC the primary way of working with patients was in groups,” notes Joanne, “so the first challenge was to replace these traditional group conversations about patient values with one-on-one talking sessions.”
Over the course of four years, the method was refined into a 30-minute discussion that helps identify each patient’s specific needs, reduce their distress and give them confidence to talk to their doctor. Questions include: ‘What would you like to ask your doctor; what do you understand about your diagnosis; do you understand your treatment options; and do you know what a clinical trial is?’
Having these questions in advance of meeting with the doctor, helps patients prepare and make best use of their brief consultation period, explained Buzaglo. It also helps distinguish what each patient desires because, after all, “different people have different goals.”
“It is important the patient understands what they’re being told and for the doctor to appreciate their level of understanding,” adds Joanne. “This creates an agenda that can be taken to the doctor and supports the patient to express their preferences, goals and values, and work in partnership to develop the best individual outcomes.”
Improving conversation and clinician understanding
The method proved successful. One of the core objectives of the project was to increase the number of patients talking about clinical trials in a consultation with their doctor – something that rarely happens unless the patient has already researched the topic. Using this approach led to 50 percent of patient participants asking their doctor about studies.
This method also enabled doctors to clarify their own way of communicating with patients.
“Key to improving the care is knowing how a patient understands their own care,” said Buzaglo. “The insights gained from this method then helped doctors understand the patient needs and preferences, and how to personalize and tailor their own communication about treatment options to the individual patient.”
Working together to break down barriers
Despite the success of the CSC’s work to develop an effective treatment support counseling program, Buzaglo recognizes that for SDM to become a gold-standard practice means overcoming more challenges. “It can be really difficult getting this kind of process into everyday care,” she asserts.
But that doesn’t mean it isn’t possible to do so. “I want all cancer patients to feel confident to ask questions of their doctors and communicate their own understanding,” Joanne notes.
“Our role is to support patients so they can express their desires and work with their doctors,” she says. “We need to support people to help them find out who they are and what they want. The only way we can do that is by working together to innovate and to bring what’s best for each patient, to the patient.”