Implementation and adoption of robust shared decision making with decision support tools requires a culture change. Provider champions advocate and act as a resource for colleagues.
Providers require education on shared decision making and how it differs from more basic patient education.
ENGAGE ENTIRE TEAM
Systems that rely solely on physicians to use decision aids experience missed opportunities and had poor uptake. Patient centered medical homes and clinics with a team-based structure can adapt existing workflows to connect patients with appropriate decision aids and not depend on providers to remember.
For example, patients eligible for colon cancer screening can be easily identified by age alone. A medical assistant or other team member can scrub the daily patient list to identify patients eligible for screening and provide them with a decision aid on colon cancer screening prior to the provider visit (i.e. at check in, via electronic health record, or mailing ). The provider can then discuss the decision aid with the patient and together come to the best decision based on the patient’s values and preferences.
IDENTIFY TRACKABLE DECISION MOMENTS
Referrals to specialists mark a trackable decision point appropriate for the use of a decision aid (e.g. patient with hip osteoarthritis referred to specialist for evaluation for joint replacement).
PATIENT OPINION TO SWAY PROVIDERS
Direct feedback to providers on their patients’ experiences with decision aids can encourage continued use and support adoption.