The Decision Aid is the Easy Part: Workflow Challenges of Shared Decision-Making in Cancer Care.
Academic Article
Overview
abstract
Delivering high-quality, patient-centered cancer care remains a challenge. Both the National Academy of Medicine and the American Society of Clinical Oncology recommend shared decision-making to improve patient-centered care. However, widespread adoption of shared decision-making into clinical care has been limited. Shared decision-making is a process in which a patient and the patient's health care professional weigh the risks and benefits of different options and come to a joint decision on the best course of action for that patient based on their values, preferences, and goals of care. Patients who engage in shared decision-making report higher quality of care, while patients who are less involved in these decisions have significantly higher decisional regret and are less satisfied. Decision aids can improve shared decision-making, for example, by eliciting patient values and preferences which can be shared with clinicians and providing patients with information that may influence their decisions. However, integrating decision aids into the workflows of routine care is challenging. In this commentary, we explore three workflow-related barriers to shared decision-making - the who, when, and how of decision aid implementation in clinical practice. We introduce readers to human factors engineering (HFE) and demonstrate its potential value to decision aid design through a case study of breast cancer surgical treatment decision-making. By better leveraging the methods and principles of HFE, we can improve decision aid integration, shared decision-making, and ultimately more patient-centered cancer outcomes.
