Shared Decision-Making for Medical Practice Variations in Elective Surgeries and Tests

Abstract

One of the motivations for developing patient decision aids is to improve decision quality and reduce unwarranted practice variations. Patient decision aids are designed to help patients discuss treatment options with their clinicians and make specific, deliberative choices. At a minimum, interventions meet the definition of patient decision aids if they make explicit the decision to be made, provide information on options including benefits and harms, and help patients clarify their values for outcomes of options. Patient decision aids appear to improve decision quality by increasing knowledge of the facts about options, enhancing realistic expectations of outcomes of options, and improving agreement between patients' values and the chosen option. Patients exposed to decision aids have lower decisional conflict, participated more actively in decision making, and were less likely to remain undecided. At the same time, patient decision aids reduce practice variation by decreasing uptake of elective surgical procedures or screening tests when baseline rates are higher than what would be expected. However, they may also increase uptake of elective surgical procedures when baseline rates are lower than what would be expected. Current practice is inadequate for ensuring quality decisions and minimizing practice variations. Patient decision aids support patients in making evidence-informed choices and may be able to inform benchmarks for the "right" rate of elective surgical procedures and screening tests.