What is Shared Decision Making for Asthma and Allergies?

Healthcare works best when doctors and patients work together to decide upon the best care for each patient. This practice is called Shared Decision Making, and it’s designed to benefit doctors and patients alike.

Shared Decision Making encourages patients and families to take a more central and active role in their care by working with their doctor to participate in the choices surrounding their treatments and medication options. It’s evidence-based and balances risks and results with a patient’s preferences and values.

Benefits of Shared Decision Making (SDM) include:

  • Increased patient knowledge
  • Improved patient self-management skills
  • Improved treatment and medication adherence
  • More certainty and less anxiety about treatments
  • Increased follow through on treatment plan
  • Alignment with patient preferences and cultural values
  • Improved patient health outcomes
  • Improved patient satisfaction with care
  • Builds a trusting relationship with one’s doctor

Several SDM tools have been developed to support this decision-making process. Clinicians and patients work collaboratively within the tool – the patient identifies preferences and values while the practitioner provides guides the conversation. The practitioner’s expertise helps to narrow the patient’s personalized options.

The patient can complete part of the tool at home and go to an office visit with their healthcare provider with printed information about their preferences to expedite the process.

    When you work with the SDM tools, you will find:

    • An introduction
    • Short-term and long-term goal setting
    • A treatment survey to identify current approaches to treatment

    What is the role of Shared Decision Making in personalized medicine?

    Targeted Therapies + Shared Decision Making = Personalized Medicine

    When healthcare professionals work with their patients to introduce treatments or medication that are specific to the patient’s needs and discuss with them their lifestyle and choices, then we see what can truly be called “personalized medicine.” It’s not a “one size fits all” approach – it’s meeting each patient where they are, involving them in the decision-making process and moving forward together to improve health outcomes.

    What Shared Decision Making tools are available for people with asthma and allergies?  

    The Shared Decision Making tools for asthma and allergies that are currently available include:

    Immunotherapy

    Developed by American College of Allergy, Asthma & Immunology, Allergy & Asthma Network

    Highlights of this tool:

    • What are the medical benefits of immunotherapy?
    • Considerations and side effects of immunotherapy?
    • Patient choices regarding shots, tablets and more

    Severe asthma

    Developed by CHEST Foundation, Allergy & Asthma Network

    Highlights of this tool:

    • What is involved with severe asthma treatment options?
    • What are the medical benefits of treatment options?
    • What are the medical risks and side effects?
    • Patient choices regarding treatments and more

    Atopic dermatitis/eczema

    Developed by American College of Allergy, Asthma & Immunology, Allergy & Asthma Network

    Highlights of this tool:

    • Introduction to Atopic Dermatitis (Eczema)
    • Topical and Systemic Treatments
    • Patient Survey
    • Information exchange between patient and provider

    Pediatric severe asthma (children and teens)

    Developed by American College of Allergy, Asthma & Immunology, Allergy & Asthma Network

    Highlights of this tool:

    • Available for 2 age groups:
      • Young Children – infant – 5 years 
      • Older Children and Teens – ages 6 – 17 years
    • How are treatments used?
    • What are possible side effects?
    • What is the cost of treatments?

    What is the process involved in Shared Decision Making?

    There are five “essential steps”  to Shared Decision Making. The five steps can be described with the acronym, “SHARE.” SHARE stands for:

    SSeek you patient’s participation

    HHelp your patient explore and compare treatment options

    AAssess your patient’s values and preferences

    RReach a decision with your patient

    EEvaluate your patient’s decision

    Step 1: Seek your patient’s participation

    Communicate that a choice exists and invite your patient to be involved in decisions.

    Patients have a right to understand their treatment options. They may choose not to participate, but try to engage them in their healthcare decisions whenever possible.

      Tips for engaging your patient:

      • Summarize the health problem.
      • Let your patient know about any options for their health problem.
      • Ask your patient to participate with the healthcare team in making healthcare decisions.
      • Include family or caregivers in discussions.
      • Remind your patient that his or her participation is important.

      Step 2: Help your patient explore and compare treatment options

      Discuss the benefits and harms of each option.

      Many healthcare decisions have multiple treatment options, including the option of no care. Often no single option is clearly superior. Use evidence-based decision-making resources to compare the treatment options.

      Tips for exploring treatment options with your patient:

      • Assess what your patient already knows about his or her options.
      • Write down a list of the options and describe them in plain language.
      • Clearly communicate the risks and benefits of each option. Explain the limitations of what is known and unknown about the treatment options and what would happen with no treatment.
      • Communicate numbers in a way that your patient can understand. Use simple visual aids (graphs, charts, pictographs) to help your patient understand your explanations.
      • Offer evidence-based decision aid tools whenever possible.
      • Summarize by listing the options again.
      • Use the teach-back technique to check for understanding. Ask your patient to explain in his or her own words what the options are.

      Step 3: Assess your patient’s values and preferences

      Take into account what matters most to your patient.

      An optimal decision is one that takes into account patient values and treatment goals.

      Tips for assessing values and preferences

      • Encourage your patient to talk about what matter most to him or her.
      • Ask open-ended questions.
      • Listen actively to your patient. Show empathy and interest in the effect that a problem is having on your patient’s life.
      • Acknowledge the values and preferences that matter to your patient.
      • Agree on what is important to your patient.

       Note: What matters most to your patient?

      It might be:

      • Recovery time.
      • Out-of-pocket costs.
      • Being pain free.
      • Having a specific level of functionality.

      Step 4: Reach a decision with your patient

      Decide together on the best option and arrange for a follow-up appointment.

      Guide your patient to express what matters the most to him or her in deciding the best treatment option. When your patient is ready, he or she will make a decision. Your patient may also choose to delegate the decision to someone else.

      Tips for decision making:

      • Help your patient move to a decision by asking if he or she is ready to make a decision.
      • Ask if your patient would like additional information tools such as educational materials or decision aids to help make a decision.
      • Check to see if your patient needs more time to consider the options or discuss them with others.
      • Confirm the decision with your patient.
      • Schedule follow-up appointments to carry out the preferred treatment or active surveillance.

      Step 5: Evaluate your patient’s decision

      Support your patient so the treatment decision has a positive impact on health outcomes.

      For many decisions, particularly those related to the management of a chronic illness, decisions can and should be revisited after a trial period.

      Tips for evaluation of the decision:

      • Monitor the extent to which the treatment decision is implemented.
      • Assist your patient with managing barriers to implementing his or her decision.
      • Revisit the decision with your patient and determine if other decisions need to be made.
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