How the Shared Decision Making Process Promotes Patient Autonomy

Decision Making, Problem Solving and Critical Thinking: The Shared Decision-Making Process

Today, there is growing recognition concerning the importance of shared decision-making for the nursing profession, but the process is challenging for multiple reasons, including most especially heightened emotions, uncertainties about the appropriate course of action and more. To determine how to overcome these constraints, the purpose of this paper is to provide a review of the relevant literature to define the shared decision-making process and its importance for professional nurses in achieving optimal clinical outcomes. Following this review, the paper provides a summary of the findings that emerged from the research in the conclusion.

Review and Discussion

As the term connotes, the shared decision-making process seeks to actively involve all of the stakeholders in a given healthcare scenario. Not surprisingly, the value of shared decision-making has long been recognized by healthcare providers, but the process was originally designed to promote a therapeutic rapport that facilitated patient-centered communications between physicians and their patients. In this regard, Inagaki et al. (2023) report that, “Shared decision-making is a model that emphasizes patient participation and was initially developed for the patient-physician relationship. A broader concept of shared decision-making has been proposed given the involvement of multiple individuals in the patient’s decision-making process in complex real-world situations” (p. 2). Given the centrality of respecting patient autonomy in promoting patient-centered care, this expansion of the shared decision-making process represented an important step.

Nevertheless, despite nearly a half century of efforts to implement this type of shared decision making in healthcare settings, there remains a lack of this process in far too many instances. For instance, a study by Pieterse et al. (2023) found that shared decision making typically involves a number of core competencies, including self-awareness of personal knowledge limitations as well as mindful messaging with patients, and impartiality with respect to patient preferences. Embodying virtues like humility, adaptability, transparency, equity, self-control, inquisitiveness, empathy, discernment, ingenuity and fortitude can empower practitioners to actively participate and guide the shared decision-making process, thereby facilitating optimal clinical outcomes and improving patient satisfaction levels (Pieterse et al., 2023).

It is important to note, though, that shared decision-making does not mean relentlessly coercing and badgering patients until they agree with nurses nor does it mean simply providing patients with all relevant information and then walking away, leaving the patients and/or their families to ponder what should be done. Indeed, there is an inherent power-relationship imbalance involved between healthcare providers and patients that places the latter at a disadvantage, especially with older adults (Martinez-Angulo et al., 2023). Like other nursing competencies, though, it is possible to learn how to encourage patients to actively participate in the decisions that will affect their health. In this regard, Zhou et al. (2023) emphasize that, “Patient-centered communication promotes positive patient outcomes. Providers’ use of first-person singular pronouns, causation and differentiation words, and clout words were positively related to perceived provider shared decision-making” (p. 1013).

It is reasonable to suggest that professional nurses not only recognize the importance of the shared decision-making process for patient wellbeing and optimal clinical outcomes, they also actively seek to find ways to improve their competencies in this area. For instance, a study by Inagaki et al. (2023) identified several aspects of patient care in challenging situations that adversely affected the decision-making process. These constraints included most especially the experience of making painful decisions amid critical healthcare uncertainties, navigating tense relationships with patients and family members, encountering emotional swings throughout the decision-making process, grappling with the challenges of coping with deteriorating medical conditions, and addressing patient desires and preferences that proved difficult to fulfill or gauge accurately (Inagaki et al., 2023).

In other words, even the most experienced and well-intended nurses are mere humans, fraught with all the frailties that characterize the human condition. Like giving their first injection, however, nurses can overcome the foregoing and other challenges to an appropriate shared decision-making process through various avenues that focus on effective patient communications, collaboration, and patient engagement such as mentors, workshops and professional development opportunities (Browne et al., 2019).

Conclusion

The research showed that engaging patients through shared decision-making promotes patient autonomy in treatment selection based on personal needs, preferences and values, enabling individually tailored care that is aligned with the fundamental tenets of patient-centered practice. The research also showed that collaborative deliberation around medical options also strengthens patient trust, rapport and consequent adherence to treatment regimens while augmenting patient knowledge, further empowering individual autonomy in managing health decisions. Finally, the research was consistent in showing that nurses can strengthen their ability to engage in shared decision-making through various avenues, thereby ultimately improving patient outcomes and satisfaction levels. It is important to note, however, that continuous self-reflection and a commitment to ongoing learning are key elements in enhancing these essential nursing skills.