“Empowering Patient-Centered Care: Breaking Barriers with Shared Decision-Making in Healthcare for Older Adults” explores the challenges of shared decision-making (SDM) acceptance in older patients. The discussion delves into the dynamics of patient reluctance, emphasizing the importance of the National Institute of Health and Care Excellence’s guideline 197 and the alignment of SDM with precision medicine. The three-talk model expands to seven, involving caregivers and visual tools to aid in effective decision-making. The benefits of SDM for older adults are highlighted, promoting improved information quality, trust, adherence, and reduced regret. Commercialized tools further empower patients to express preferences and compare options.

Introduction

The concept of geriatrics revolves around the “5 As individuals age into their elderly years, the significance of shared decision-making becomes paramount. This collaborative approach involves clinicians and patients working together to diagnose, test, and manage treatments, informed by clinical evidence and patient input. The core principle is encapsulated in the slogan “no decision without me.” The evidence-based roadmap for knowledge translation includes five key components (5 A’s), encompassing clinical coaching, research database acquisition, evidence appraisal, application for individual health, and adherence to evidence-based knowledge. This shared decision-making, also termed value-based decision-making, is crucial in individualized patient care.

The urgency of healthcare and research quality underscores the importance of shared decision-making, outlined in five steps. These steps involve patient participation, exploring and comparing treatment options, assessing patient values and prevalence, reaching a decision, and evaluating patient satisfaction. More than a decade ago, Washington State initiated legislation to sensitize the FDA, leading to the development of the SVM model under Obamacare. 

This model acknowledges the unique needs and values of patients with disabilities and older patients, emphasizing a healthcare decision-making pathway tailored to their specific requirements. National standards, such as Patient Decision Aids, were established to ensure effective communication and healthcare delivery.

Shared decision-making aims to achieve the right treatment for the right patient at the right time, emphasizing not only treating but also considering non-treatment options. The goal is to provide personalized and considerate healthcare, recognizing the diverse and sensitive needs of individuals as they age.

Complexity of Healthcare and the Crucial Role of Shared Decision-Making in Precision Medicine for Older Adults

As we delve into the realm of ageing individuals, particularly the elderly, the importance of shared decision-making comes to the forefront. Shared decision-making entails a collaborative process wherein clinicians and patients collaborate in diagnosing, testing, and managing treatments, incorporating clinical evidence and patient insights. The three-talk model serves as a practical approach where interactions with patients, especially older ones, are crucial. Traditional models, such as the surgery model proposed in the US and the UK, focus on option talk, decision talk, and subsequent dialogue.

The shared decision-making journey involves a comprehensive understanding of patients’ concerns, considering physical, psychological, spiritual, and social aspects. The goal-based stay model, emphasizing the fundamental goals of life and addressing geriatric syndromes like mobility, proves particularly useful for older adults. This approach prioritizes aspects such as symptom management, functional improvement, and maintaining independence. The traditional schedule model primarily adheres to the 3D talk model, emphasizing options, talk, and the decision hub.

However, further development introduces the need for extensive preparation, delving into patient’s goals and choices, and addressing diverse concerns. Interprofessional collaboration becomes pivotal, involving caregivers, families, nurses, pharmacists, rehabilitation therapists, nutritionists, and social workers. The shared decision-making process extends beyond the patient-physician relationship, encompassing a broader circle of involved professionals and family members.

The evolving model integrates evidence-based medicine and patient-centered communication, emphasizing the importance of health literacy. A paper in JAMA in 2014 highlights the significance of this approach, recognizing that shared decision-making is an outcome stemming from evidence-based practice. The incorporation of health literacy scales further refines the model.

Breaking Barriers to Shared Decision-Making in Healthcare for Older Adults

And what is the barrier for our patients that will refuse or cannot accept schedule-making communication? It is the knowledge of games and the power provided by our healthcare profession, like they don’t have the cyber currency and they are afraid of the autonomy of the clinicians.

In the context of shared decision-making (SDM), patient resistance often stems from a lack of understanding and perceived power imbalances in healthcare dynamics. The hesitancy arises from patients feeling they lack the necessary knowledge and being apprehensive about the dominance of healthcare professionals.

Two years ago, the National Institute of Health and Care Excellence (NICE) introduced Guideline 197, emphasizing shared decision-making as a clinical pathway. This guideline underscores the importance of collaborative decision-making, gathering evidence, and respecting patient preferences. SDM aligns with the objectives of precision medicine, aiming for personalized, evidence-based care.

SDM shares commonalities with precision medicine, such as a patient-centered approach, autonomy, predictive uncertainty, and individualization. Both models consider the patient’s life course, humanistic approach, environment, and participation, providing a dynamic framework for decision-making.

In addressing multiple chronic conditions, especially in older adults, the three-talk model expands to seven, involving not only clinicians and patients but also caregivers. Emphasizing consensus-building among patients, families, and healthcare providers becomes crucial in navigating potential conflicts and ensuring a well-rounded decision-making process.

Visual tools play a pivotal role in decision-making, aiding patients in understanding options and weighing pros and cons effectively. An example illustrates how SDM can guide an older woman with breast cancer to make an informed decision, considering factors like survival rates, cost, and physical burden.

The potential benefits of SDM for older adults include improved information quality, increased trust in communication and physician-patient relationships, enhanced adherence, reduced regret, and heightened confidence in decision-making.

Commercialized tools, like colorful decision cards, further empower patients to express their preferences and compare options, facilitating discussions with healthcare professionals. This collaborative approach aims to ensure that decisions align with patients’ values, preferences, and current circumstances.

Conclusion

The transformative potential of shared decision-making (SDM) in healthcare for older adults is evident. Overcoming barriers to acceptance, SDM aligns with precision medicine, emphasizing patient-centered care. The expanded seven-talk model, involving caregivers, enhances consensus-building. Visual tools play a crucial role in facilitating informed decisions. The benefits of SDM, including improved information quality and increased patient confidence, underscore its significance in promoting patient empowerment. Commercialized tools further facilitate collaborative decision-making. As highlighted in a JAMA article, implementing SDM requires a balanced approach, emphasizing ongoing preparation among clinicians and in clinical practice.