Shared decision making: what do clinicians need to know and why should they bother?

To the Editor: The article by Hoffman and colleagues1 outlines the importance of fully involving people in decisions about their health care. There is an ethical imperative to ensure that both patients and the community obtain the best value possible from the resources that are used to provide health care. A low-technology intervention that can help meet the expectations for better value care should be warmly embraced. We now need to find practical ways to increase the use of shared decision making in routine practice.

As Hoffman et al note, this will require concerted effort across the system. Health professionals need the skills required to use shared decision-making approaches. Professionals and patients need high-quality decision aids that can help identify patient preferences where there are multiple options for treatment. And there is clearly a need for research that measures the uptake and effects of shared decision making in specific clinical areas.

In October 2014, the Australian Commission on Safety and Quality in Health Care sponsored visits by two international experts in shared decision making, to explore what we can learn from overseas experience in this area. Professors Richard Thomson (Newcastle University, United Kingdom) and Dawn Stacey (University of Ottawa, Canada) led workshops that aimed to identify cost-effective ways of ensuring that high-quality patient decision aids are accessible, available and used in Australia.

In the coming year, the Commission will be working with educational and consumer groups to develop content for an online risk communication training module for health professionals.

We will also be undertaking work to develop and promote patient decision aids in specific areas. Recently, the Commission led Australia's contribution to a study by the Organisation for Economic Co-operation and Development exploring inter- and intra-country variation for selected procedures (detailed Australian results can be found at http://www.safetyandquality.gov.au/publications/exploring-healthcare-variation-in-australia).

We are now building on this work to develop an Australian atlas of health care variation. The Commission will work with clinical and consumer groups to identify areas where there are substantial, potentially unwarranted areas of variation. It will also work to promote greater use of shared decision making in these areas, including the development of patient decision aids and training for health professionals in their use.