Strategy. Patient Shared Decision Making
Approach. Expand patient shared decision making to pediatricians to better serve children in a family centered manner
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Overview. Under a shared decision making (SDM) process, health care practitioners and patients work together to make joint decisions about a patient’s care, informed by the patient’s preferences and values. SDM requires that patients be educated about and understand the risks and benefits of their options; education is often through decision aids such as pamphlets, videos, and computerized tools. SDM is an important part of patient-centered care.[1]
Evidence. Scientifically Rigorous Evidence.
Strategies with this rating are most likely to be effective. These strategies have been tested in multiple robust studies in a variety of populations and settings with consistently positive results, both on their own and in combination with other strategies. (Clarifying Note: The WWFH database calls this "scientifically supported evidence").
Access the peer-reviewed evidence
through the MCH Digital Library or related evidence source.
(Read more about understanding evidence ratings).
Source. What Works for Health (WWFH) Database (County Health Rankings and Roadmaps)
Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):
- Patient Experience of Care. This study improves individuals' perceptions, feelings, and satisfaction with the healthcare services they receive.
- Quality of Care. This strategy promotes the degree to which healthcare services meet established standards aimed at achieving optimal health outcomes.
- Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.
Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.
Intervention Type. Direct Care (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).
Intervention Level. Individual/Family-Focused
Examples from the Field.
There are currently no ESMs that use this strategy. As Title V agencies begin to incorporate this strategy into ESMs, examples will be available here. Until then, you can search for ESMs that have similar intervention components in the ESM database.
Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).
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Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")
- Number of pediatric practices that adopt and implement SDM tools and process as part of their standard of care. (Shows the spread and scale of the approach)
- Number of children and families who participate in SDM discussions with their pediatricians regarding treatment options, goals, and preferences. (Indicates the reach and engagement of the population served)
- Number of children who receive care that aligns with their and their families' informed preferences and values as a result of SDM with pediatricians. (Shows the approach's impact on delivering patient-centered care)
- Number of pediatric health outcomes (e.g., treatment adherence, symptom control, quality of life) that are improved through the use of SDM between children, families, and pediatricians. (Indicates the approach's effect on enhancing the effectiveness and appropriateness of care)
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Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")
- Percent of pediatric visits that include the use of validated SDM tools (e.g., decision aids, conversation guides) to facilitate informed and collaborative decision making. (Shows the consistency and fidelity of the approach's implementation)
- Percent of children and families who report receiving clear, comprehensive, and unbiased information about treatment options and potential outcomes during SDM with pediatricians. (Indicates the quality and effectiveness of the decision support provided)
- Percent of pediatric treatment plans that are jointly developed and agreed upon by children, families, and pediatricians through SDM process. (Shows the approach's effect on promoting collaborative and consensual decision making)
- Percent of children and families who adhere to and express satisfaction with the chosen treatment course following SDM with pediatricians. (Indicates the approach's influence on treatment buy-in, follow-through, and outcomes)
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Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")
- Number of pediatric-specific SDM tools, resources, and best practices developed and disseminated to support widespread adoption and implementation. (Shows the creation and sharing of knowledge assets to facilitate the approach)
- Number of policies or incentives (e.g., reimbursement models, quality measures) established to encourage and sustain the use of SDM in pediatric care. (Indicates the enabling factors and system changes needed to support the approach)
- Number of pediatric adverse events, complications, or unnecessary treatments avoided as a result of informed and shared decision making between children, families, and pediatricians. (Shows the approach's impact on improving patient safety and reducing harm)
- Number of healthcare dollars saved by aligning pediatric care with evidence-based guidelines and patient preferences through the use of SDM. (Indicates the approach's potential for reducing waste and increasing value in pediatric healthcare spending)
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Quadrant 4:
Measuring Quality of Effect ("How are they better off?")
- Percent of pediatric practices that regularly assess and address health literacy, cultural, and linguistic barriers to effective SDM with children and families. (Shows the equity and inclusivity of the approach's implementation)
- Percent of pediatric professional education and training programs that include SDM and family-centered care as core competencies. (Indicates the integration and sustainability of the approach in workforce development)
- Percent of children and families from groups experiencing marginalization who report meaningful involvement in shared decision making with their pediatricians. (Shows the approach's impact on reducing disparities and ensuring equitable access to patient-centered care)
- Percent of pediatric healthcare organizations that demonstrate a culture shift towards prioritizing and incentivizing SDM and family-centered care as key drivers of quality, safety, and value. (Indicates the approach's influence on transforming organizational norms, values, and practices)
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Note. When looking at your ESMs, SPMs, or other strategies:
- Move from measuring quantity to quality.
- Move from measuring effort to effect.
- Quadrant 1 strategies should be used sparingly, when no other data exists.
- The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.
Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.
References
[1] Cochrane-Legare 2014 - Légaré F, Ratté S, Stacey D, et al. Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database of Systematic Reviews. 2014;(5):CD006732.
