Shared decision making (SDM) is all about learner-centered approaches; it allows for the patient to own his/her disease management in a way that produces desirable clinical care outcomes. 

SDM is all about creating concordance, empowerment, engagement, participation, and independence.  This allows each patient to define his/her needs with the diabetes team.

Compliance, adherence, and behavior change are one-dimensional approaches that put a provider in charge of a patient’s condition. However, with chronic conditions we really need to allow the patient to be in charge as he/she is the one that has to take care of almost 100% of the interventions. We really cannot make a patient adhere to, or comply to, his/her diabetes plan; but what we can do is to build confidence in their ability and willingness to do something better with their daily routine.

Tailoring our education and conversation approaches to the needs of a learner is critical now with the shift from fee-for-service to value-based, pay-for-performance, and outcome driven interventions. In the past, as long as patients were informed about their diabetes, we did our job as diabetes educators. Now we are accountable for making sure that patients are actually learning information that is relevant enough for them to generate improvement in their self-care behaviors.

Shared decision making is done with effective conversations we have in group or individual settings. An excellent example is the Mayo Clinic’s Shared Decision Making National Resource Center with decision making tools that allow patients to make decisions about:

◦          HbA1c reduction

◦          Daily routine

◦          Low blood sugar

◦          Costs

◦          Daily sugar testing

◦          Other considerations

◦          Weight Change

Patients are able to weigh in on deciding how much each medication will reduce their A1c, produce weight loss vs. gain, how much will it cost, or how many doses are needed. This way, at their office visit, we proactively eliminate the unknown of adherence and the potential barriers with actively involving one with situational problem solving. The patient determines what will work for him under his unique preferences and circumstances.

What are some of your approaches to shared decision making?  What works vs. what does not?