Health Equity Spotlight: Shared decision making
If you speak with your health care provider, do you have a chance to ask questions? Do they listen to your needs and concerns? Do they offer options or alternatives to the care you’re seeking? Do they ask about your personal preferences or values? Do you get a say in the health care and treatment you receive? If you’ve answered yes to any of these questions, chances are you and your health care provider are engaging in shared decision making (SDM).
Shared decision making and health equity
SDM empowers patients and their families in making health care decisions with their providers, ensures unbiased presentation of options, and reduces provider assumptions about patient values. It considers what is important to the patient — and clinical evidence — so the patient can choose what is right for them.
Studies have shown that the use of patient decision aids (PDAs) can reduce disparities in care by increasing access to appropriate treatment in underserved populations, while decreasing inappropriate overuse in other populations.
One study found that eight in 10 people want their health care provider to listen to them, but just six in 10 say it actually happens. SDM aims to change that percentage by providing information that allows patients and providers to make health care decisions together. At Health Care Authority (HCA), we educate providers and patients on SDM and provide tools like PDAs to help facilitate SDM.
Shared decision making in Washington
Washington is a leader among states in using and certifying PDAs, working with state and national partners, as well as the Bree Collaborative, Kaiser, Accountable Care Programs (ACPs), and other health systems.
- In 2007, Washington became the first state to pass legislation on shared decision making.
- In 2012, state legislation granted HCA the authority to certify high-quality PDAs. The International Patient Decision Aid Standards Collaborative guides the certification criteria and its development process and effectiveness.
- In 2016, HCA worked with state and national experts to develop and implement a one-of-a-kind process to certify PDAs. Since then, HCA has certified over 50 PDAs for topics including end of life care, orthopedics, maternity, and screening for cancer.
- In 2017, HCA began working with the Bree Collaborative to develop practical guidance on SDM implementation to increase provider adoption of SDM.
How does shared decision making help advance equity for the people we serve?
The goal of SDM and using PDAs is for clinicians to engage with patients in their discussions. SDM began in response to the high variation in care that people in Washington were receiving. Using unbiased, certified PDAs reduces variations in care, which limits health disparities and increases equity without limiting patient choices. It gives patients the opportunity to have preference-sensitive care — care that aligns with their cultural and personal beliefs — and even the right to say “no” and take a watch-and-wait approach.
What is something you’d like people to know about your work?
SDM is personal and applies to everyone since we all make decisions in our health care. With SDM and PDAs, we can take some responsibility for our care by talking to our physicians. We can also support our loved ones who are using SDM and PDAs.
What is the one thing people can do today to advance health equity, either personally or professionally?
Let others know they have the right to access resources that’ll help them make informed decisions. This includes sharing what PDAs are and how providers can use PDAs to improve patient experiences.
Check out HCA’s website for resources for yourself and others:
- The SDM page includes an SDM fact sheet and links to SDM training.
- The PDA page has links to certified PDAs for maternity and labor/delivery, total joint replacement and spine care, end of life care, and cancer screening.
On a personal note, ask questions so you fully understand the options for conditions that have multiple treatments.
What do you enjoy most about this work?
We all feel pretty passionate about this work — we like that it provides an opportunity to honor patient choices in the decision making process. It also helps provide an awareness of options for preference-sensitive decisions and empowers patients to make informed decisions based on their values and lived experiences.
Health equity work at HCA
We’re making intentional efforts to address health equity and diversity, equity, inclusion, and belonging (DEIB) in all our practices. For example, we’re applying a health equity lens to HCA’s books of business.
This includes (but is not limited to):
- Health insurance programs: Apple Health (Medicaid) and School & Public Employees Benefits Boards (SEBB & PEBB)
- Prevention, treatment, and recovery behavioral health programs
- Medicaid Transformation Project (MTP) waiver renewal
- Efforts to lower health care costs for consumers and increase transparency
- Eliminating Hepatitis C
- HCA policies, such as Plain Talk
- And more
Our vision is that HCA employees embody a culture in which we openly recognize health inequities and are empowered to work together, and with the people we serve, to reduce inequities through fair and equitable distribution of programmatic, financial, and informational resources.