A study analyses shared decision-making in screening programmes

Improving the communication skills of healthcare professionals and increasing the time they can devote to patients is a prerequisite for introducing shared decision-making in screening programmes. A proactive attitude from both sides would also facilitate its implementation

From left to right, the researchers Maria José Hernández, Misericordia Carles and María José Pérez.

Shared decision making (SDM) in generic health settings differs from SDM in screening programmes. In former it is sick patients who have to decide between possible treatments, while in the other it is healthy users who decide how to diagnose a possible illness in a preventive context.

The main function of screening programmes is the early detection of diseases. However, despite their undeniable benefits, they also have adverse effects, such as overdiagnosis and overtreatment, false positives and false negatives. The benefits and adverse effects generate uncertainty for users that can be reduced, in part, through the practice of SDM among healthcare professionals and patients. Such a decision-making process allows for the views of health professionals who are experts in scientific evidence and patients who are experts in their own experience and beliefs about their health condition to be taken into account.  In this way, it increases the participation of patients in their care decisions and thus improves their satisfaction and the usefulness of the decisions taken. In this way, it increases the participation of patients in their care decisions and thus improves their satisfaction and the usefulness of the decisions taken.

It is for this reason that researchers from the URV’s Department of Economics Misericòrdia Carles, María José Hernández, María José Pérez, together with researchers from other Spanish institutions, have recently published in the journal Patient Education and Learning, from the perspective of health professionals, the facilitators and barriers that either help or hinder the application of SDC in different screening programmes, through a review of the scientific literature.

The results have shown that the elements that constitute both barriers and facilitators can have their origin in three agents involved, namely the health system, the patient and the health professional.

The main barriers to implementation

One barrier is the fact that the lack of information on the adverse effects of cardiac arrest is a limiting factor in the decision making process between the professional and the patient. In view of this, education and training in risk communication for health professionals continues to be an objective that needs to be achieved in order to be able to inform patients of the risks and benefits of screening in a balanced and simple way.

Nonetheless, the most frequently mentioned barriers come from the health system, of which the limited time allocated to medical visits is the most frequent. The review shows that to implement shared decision making would require almost twice as much time as is spent on a follow-up visit in primary care.

Furthermore, the professionals were concerned about possible claims of negligence in the event that the joint decision resulted in the patient not being screened and then being diagnosed late. However, the research shows that this concern is unfounded, as patients who adhere to shared decision-making feel more involved in the decisions taken and thus tend to generate fewer complaints.

They also describe as barriers the lack of flexibility in the protocols for adapting the criteria of the panel to each patient’s case. In view of this, they conclude that evidence-based medicine must be combined with shared decision-making, as the preferences of patients are taken into account, thus making them jointly responsible for their care.

The facilitators are the attitudes of the healthcare provider and the patient

Another key facilitators, among health professionals, an is attitude that seeks continually to actively involve the patient. If this same attitude is transmitted to the patient, and they are willing to participate in decisions regarding their health, then this too facilitates the implementation of SDC.

Finally, professionals consider it a facilitating factor that patients are able and have the skills to access, understand and use health information, as this makes them more aware of the implications of the screening process.

The project researchers consider that decision-making aids – such as leaflets and explanatory videos – would enable the model to be used by professionals to help them to communicate benefits and adverse effects in a balanced way, and that patients would be helped to understand the basic concepts and outcomes of prevention programmes in order to support their own choices.

Bibliographic reference: María José Hernández-Leal, María José Pérez-Lacasta, María Feijoo-Cid, Vanesa Ramos-García, Misericòrdia Carles-Lavila “Healthcare professionals’ behaviour regarding the implementation of shared decision-making in screening programmes: A systematic review,” Patient Education and Counseling, 2021, ISSN 0738-3991, https://doi.org/10.1016/j.pec.2021.01.032.

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