Delivering high-quality care starts with understanding what matters most to each patient. Clinicians can’t choose treatments that match patients’ priorities and values until they engage with them.
The process of communicating and engaging with patients is dependent upon two foundational pillars of patient-centric care: participating in shared decision-making and obtaining informed consent, better termed “informed choice.” Patients can exercise informed choice only when they are truly made aware of the risks, benefits and alternatives that exist relative to treatment.
What is shared decision-making?
Shared decision-making is a process by which healthcare providers work collaboratively with their patients to make decisions about the most appropriate treatment, using the following criteria:
- Best available evidence
- Clinical expertise
- Patient values, preferences and circumstances
Shared decision-making moves conversations from “What’s wrong with me?” to “What matters to me?” Models of shared decision-making emphasize understanding patients’ preferences, needs and values when weighing options, which require open patient-clinician communication.
What is informed consent (informed choice)?
Informed consent is a legal and ethical requirement to ensure that patients fully understand their treatment options, including potential benefits, risks and alternatives. Effective informed consent adheres to the BRAN communication framework, answering key questions:
- Benefits: What are the potential positive outcomes?
- Risks: What are the potential negative outcomes?
- Alternatives: What other treatment options exist?
- Nothing: What happens if no treatment is pursued?
Patients should receive this information clearly at every clinical encounter before agreeing to treatment. Importantly, according to the Joint Commission, only one in four consent forms contains all the BRAN elements. Ultimately, this framework transforms informed consent into informed choice, which is the goal of the process.
How do informed consent and shared decision-making affect patient experience, outcomes and cost of care?
Research shows that informed consent and shared decision-making improve patient satisfaction, enhance treatment adherence and health outcomes and help reduce the overall cost of care. When armed with full information and engaged in choices aligning treatments to their priorities, patients experience fewer regrets, better-perceived communication and more active engagement in their care. Shared decision-making also minimizes unwarranted variation in clinical practice.
Because patients are often more risk averse than clinicians, they will often choose more conservative and less costly treatments before surgery when presented with their options. As a result, the total cost of care decreases.
How do clinicians communicate risk to the patient effectively?
How we share risk proportion is often driven by our own personal biases, so it’s important that when sharing an absolute number to represent risk, it’s vital to also share the inverse to frame risk appropriately. Furthermore, clinicians should not only state the inverse statistic but also convert both statistics to absolute numbers.
Clinicians need to be educated on how to communicate not just the numbers, but the benefits, risks and alternatives in a compassionate and meaningful way. To fully contextualize decisions for a given patient, the physician must understand the material and cultural conditions of that patient’s life: where they live, whether they have access to reliable transportation and housing, their level of literacy and numeracy and other related factors.
Our ability to understand these various elements in the context of the human being in front of us is critical to the BRAN conversation. This context is paramount in our ability to effectively obtain informed choices and provide high-quality care that aligns with patients’ needs.
Read more about shared decision-making and informed choice, including how to assess and improve the quality of both, as well as what tools are available to make adoption and assessment of them easier.
Emily Olsen 
Ricky Zipp 
Susanna Vogel