Learn about shared decision-making and how it helps providers and patients treat substance use disorders.
Shared decision-making (SDM) is defined as an approach where clinicians and patients share the best available evidence when faced with the task of making decisions, and where patients are supported to consider options in order to achieve informed preferences. This is in opposition to a historical model where providers have traditionally made decisions on the behalf of their patients. SDM is different than traditional approaches where providers are considered to know best and patients just defer to their expertise. Glyn Elwyn, a leading physician-researcher on SDM, recommends a three-step SDM model that urges providers to:
- Introduce choice
- Describe options, often by integrating the use of patient decision support
- Help patients to explore preferences and to make decisions
SDM is invaluable when there truly are treatment choices and no absolute best option. One such example occurs in the treatment of substance use disorders. Services range from abstinence to harm reduction and treatment. Treatment includes, but is not limited to, counseling, naltrexone, and medication-assisted treatment (MAT) with buprenorphine or methadone.
Though barriers to practicing SDM include time constraints, a perception that patients do not prefer SDM, and opposition to asking patients about their preferred role in decision-making, researchers have found that SDM reduces drug use and psychiatric severity in substance-dependent patients.
A 2008 review of barriers and facilitators to implementing SDM indicated that some health professionals perceived time constraints, a belief that patients do not prefer SDM, and opposition to asking patients about their preferred role in decision-making as barriers to using SDM in clinical practice. However, using a SDM approach may lead to positive outcomes; a 2009 study suggests that SDM reduces drug use and psychiatric severity in people with substance use disorders.
Further, a Cochrane Systematic Review of decision aids found that compared to usual care, SDM improved knowledge, produced more realistic expectations, lowered decisional conflict, increased the proportion of people active in decision-making, reduced the proportion of people who remained undecided, and produced greater agreement between values and choice.
Many elements of SDM are already included in the daily practices of human service providers, such as patient-centered care and strength-based approaches. As a supplement to these skills, many tools and guides exist for both providers and patients. SAMHSA offers guidance on SDM, including the publication Shared Decision-Making in Mental Health Care: Practice, Research, and Future Directions – 2011.
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