How to Be a Co-Pilot with Your Doctor: Shared Decision-Making in Health Care

by Ron Pollack

(Editor's Note: Ron Pollack is the executive director of Families USA, the national organization for health care consumers.)
Health care experts are rediscovering an old-fashioned concept that may help lower health-care costs and improve the quality of health care: shared decision-making. What is shared decision-making? It is when you and your doctor work together as co-pilots as you travel through the health care system. And you have the right to ask your doctor to use shared decision-making whenever you need to decide among several treatment options.

What does shared decision-making mean?

Shared decision-making can mean different things depending on the situation. But one of its central ideas is that we need to get patients (and, when appropriate, families) and caregivers more involved in health-care decisions. The main goal of shared decision-making is to give patients the knowledge and skills they need to take an active role in their health care.
Using shared decision-making is especially important when a patient has a medical condition that has more than one medically sound treatment option. In these cases, there is no single, correct medical solution — the best solution depends on the patient's personal preferences and values.

What are the elements of a shared decision-making program?

All shared decision-making programs should contain four fundamental elements:

  1. Information
    Patients should receive clear and unbiased information that describes their condition, that addresses the pros and cons of different treatment options, and that helps them envision how their life might change based on their decision.
  2. Support
    Patients should be well supported during the decision-making process. They should get help understanding the information given to them and should feel free to discuss their values and preferences with their provider.
  3. Discussion
    Patients and providers should share information and make a decision together that is based on the best medical evidence and tailored to the specific needs and circumstances of the patient.
  4. Follow-Through
    Care should be delivered in the agreed upon manner and in a way that respects patients' preferences and values. Patients should stay in contact with their providers and continue to receive support for other health care decisions.

What are patient decision aids?

Patient decision aids are written, video, or web-based tools that are designed to help patients do the following

  1. Become more knowledgeable about their health condition and treatment options;
  2. Decide which risks and benefits are most important to them; and
  3. Envision how the different options would affect their daily lives.

When designed well, these decision aids can help patients make choices that reflect their preferences and values.
Although shared decision-making programs do not necessarily need patient decision aids to be effective, it is essential that patients be well-informed and feel empowered to participate in the decision-making process.