Shared decision making (SDM) refers to a treatment decision made by a health care provider and a peer (individual living with mental health conditions) acting as partners. SDM is different from the traditional model of health care, which is sometimes called a “paternalistic” model, in which the provider makes all the decisions and is responsible to educate the peer only to the extent required to attain treatment compliance. In SDM, the provider and peer share information about treatment options and arrive at a consensus. The SDM model empowers people who are seeking treatment or in recovery to be active in their own treatment. Research shows that peers “who believe they are actively involved in treatment decisions generally have better outcomes, whereas having a low sense of control over decisions is associated with less behavioral involvement in care, poorer self-rated health, and increased illness burden.”
There is currently no legal standard or procedure in approaching shared decision making. Generally, the process includes these steps:
- Recognizing that a decision needs to be made;
- Identifying the peer and the provider as equals;
- Stating and understanding the options;
- Exploring the options and expectations;
- Identifying preferences;
- Negotiating options;
- Sharing the decision; and
- Arranging follow up to evaluate outcomes.
Resources and tools can be used by peers on their own (or with the assistance of others) to facilitate SDM. A common option is decision aids (DAs), which can help a peer identify treatment options and explore their preferences prior to meeting with a provider. DAs have been shown to decrease this decisional conflict or uncertainty, which can in turn reduce treatment delays. The International Patient Decision Aids Standards (IPDAS) Collaboration has developed a set of standards for health care DAs. A number of decision aids are available to peers, although not all of them meet IPDAS standards:
- WebMD provides lists of “Questions to Ask Your Doctor” for different conditions, which can facilitate informal shared decision-making.
- The Ottawa Health Research Institute maintains a database of decision aids that meet IPDAS criteria here. The Web site also includes the Ottawa Personal Decision Guide, which is designed to assist individuals in making any health care or social decision.
- The Mayo Clinic provides a decision aid for depression medication here.
- Additional SDM resources can be found here and here.