Decision making carries more risk in the following situations
- Elective treatments
- Patients with high aesthetic/cosmetic demands
- No dental consensus
- Multiple treatment options
- Potential for significant adverse outcome/additional cost
Numerous studies have shown that clinicians’ assumptions of patient values on which they may base their recommendations regarding investigation or treatment can be inaccurate. Better informed patients often make different choices eg more conservative treatment and are more risk averse. What patients want is often different from what clinicians think their patients want. The literature also suggests that when patients make these decisions they are more satisfied.
Often we decide what we think is in the patient’s best interest from a clinical perspective, inform them as to why we have arrived at that decision and then give them details of the risks and benefits. This represents more persuasion than collaboration, i.e. making decisions for rather than with the patient. The danger is that the patient may feel that they have been pushed into care or treatment that they did not want.
Patient preferences for involvement in decision making
Resistance to shared decision making often revolves around a perception that dentists have many patients who wish the dentist to make the decision for them: “Whatever you think best”. The difficulty is that just as Dentists have preferences for their style of decision making, patients also have preferences as to their desired level of involvement.
This is context dependant and can change with time. For example a patient’s desire to be involved in an elective procedure is likely to be very different than if they are in severe pain such as with a large abscess when they may be only too willing to devolve decision making responsibility to the dentist.
Regarding the passage of time, should the patient experience an adverse outcome from their treatment, perhaps involving significant extra cost, their preference about how much they should have been told and involved may well be different in retrospect.
What is shared decision making?
Shared decision making is both a philosophy and a process whereby the patient and professional work in partnership to make decisions about care where there is more than one beneficial way forward.
Shared decision making takes into account:
- Scientific knowledge and evidence
- Patient autonomy
- Patient value