Do your customers have to make medical decisions? Are you aware of the criteria they use to decide what to do?
In many scenarios, there is more than one clinically appropriate intervention strategy.
In the case of a broken leg, it is usually clear what to do. But what about after cancer surgery - should you follow up with medication or would you rather just actively monitor?
In addition to the purely "scientific" side, questions of a patient's health-related quality of life, which is limited by the side effects of a therapy, for example, quickly come into play.
This quality of life is not a purely medical phenomenon; it also includes emotional, social or even mental aspects. For example, hair loss associated with chemotherapy has hardly any medical implications - but it can severely limit a person's self-confidence and social quality of life.
Medicine is moving further and further away from patriarchal models, in which a "demigod in white" tells the patient what to do from a medical point of view. It is now known that a shared decision-making process (SDM) between physician and patient or family member can lead to better therapeutic outcomes.
The more a decision requires subjective trade-offs between potential benefits and harms, the more the patient's perspective must be incorporated.
The best therapeutic option then depends on the patient's values regarding the benefits, harms, and scientific uncertainties of each option (J. Wennberg et al.).
Most physicians know this. However, shared decision making is hindered by time pressures, care from multiple specialists, sometimes bias on the part of physicians, or ignorance and reluctance on the part of patients. There is also evidence of a discrepancy between the perception and reality of shared decision making due to misunderstandings about the nature of shared decision making, the skills it requires, the time it takes, and the extent to which patients, families, and caregivers want to participate in decision making (Hoffmann TC et al. 2014).
Fundamentally problematic is that many patients themselves are not aware of what is most important to them in terms of their health.
In addition, they are often mentally overwhelmed to think about their values in critical situations. Even more so when it comes to benefits or risks that will only manifest themselves in the future.
Typically, in stressful situations, we draw on decision-making heuristics (i.e., knowledge that we have stored in our memory based on past experiences and can recall "automatically").
Heuristics are very useful for routine decision-making. However, when making a medical decision that may be vital, they run the risk of overestimating incomplete information, ignoring information gaps, or making conclusions based on perceived rather than real probabilities. Often, the patient does not notice his or her wrong decision in time. In addition to dissonance, the consequences can include a lack of adherence to therapy, discontinuation of therapy, or even a reduction or complete lack of therapeutic success.
- One approach to solving this problem is to train the physicians' side in terms of their communication or empathic skills.
- On the patient side, efforts are being made to offer innovative decision-making aids that provide information on the benefits and risks of a therapy. Once informed, the patient participates in the decision-making process to the extent he or she desires.
- Innovative shared decision-making solutions use behavioral science insights and so-called "patient profiling".which starts with a patient's basic health preferences, which can then be universally incorporated into treatment decisions. The patient gets to know himself better and is empowered to express his preferences in dialogue with physicians.
Decisions can finally be transferred from an intuitive level of heuristics in "system 1" of the brain to the so-called "system 2", which is more strongly based on logically reasoned conclusions.
Perceptual distortions can be eliminated and decisions can be more closely linked to a patient's true preferences. Confronting future scenarios helps patients to better imagine their own future and the impact of different treatment options on it.
It is important that in relation to possible therapies, their risks and benefits are put into an everyday context and visualized in an understandable way (e.g., it turns out that absolute frequencies are better understood than relative frequencies, a 10% mortality rate is perceived differently than a 90% survival probability). It is imperative that patients' health and numeracy skills be incorporated into the development process. (Bonner et al. 2021)
The requirements for shared decision making in a medical context are constantly evolving.
Not least because interactions outside the traditional face-to-face encounter with a physician, comorbidities, ethnic or cultural idiosyncrasies, country-specific differences, and evidence-based medicine findings need to be increasingly incorporated.
However, the potential of various technologies combined with behavioral science insights holds promise for promoting decisions that all stakeholders can get behind.
Examples of decision support tools for patients to take a more holistic view of treatment decisions
- Option Grids: Option grids are clear decision aids that present patients with a list of options with the advantages and disadvantages of each option. They are designed to be easy to use and understand, and can be used by patients alone or with the help of a healthcare professional.
- Patient information videos: Patient information videos are short, animated videos that provide patients with information about their health condition, treatment options, and potential outcomes. They are designed to be engaging and easy to understand, and can be used by patients on their own or with the help of a healthcare provider.
- Personalized decision-making tools: Personalized decision aids use patient-specific data, such as medical history and preferences, to provide tailored information about treatment options and potential outcomes. They can help patients make more informed decisions about their healthcare and can be used in conjunction with other decision aids.
- Decision support with interactive functions: Decision aids with interactive features, such as quizzes or decision trees, engage patients in the decision-making process and can help them better understand their options and preferences. This is also where virtual reality tools can play a role in connecting patients with their future selves. One such example is the "Should I screen" tool in lung cancer screening, which interactively considers individual patient risks, or in "Future-Self" regarding substance abuse management.
- Mobile apps: Mobile apps can provide patients with on-the-go decision support, allowing them to access information about their health options anytime, anywhere. Some mobile apps also offer interactive features and personalized decision support, which provide the ability to review decisions for validity over time as well.
Are you a provider of health carengene or therapies? Talk to us about how you can build up your services in a patient-centered way!
