Wrap-Up—Empowering the Patient: Shared Clinical Decision Making and Advocating for the Patient

In this video, Linda Davis, MD, provides a review of her session, "Empowering the Patient: Shared Clinical Decision Making and Advocating for the Patient" at Practical Updates in Primary Care. In her session, Dr Davis speaks about the collaborative approach between patients and their clinicians, case study examples that show the use of shared clinical decision making in practice, what a patient advocate looks like, and more. 

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TRANSCRIPTION:

Linda Davis, MD: Hello, I'm Dr. Linda Davis with Colvita Family Medical Group in Mission Viejo, California. And I want to thank those of you who were able to join me during my session, "Empowering the Patient: Shared Clinical Decision Making and Advocating for the Patient."

And for those of you who weren't able to join me, I just wanted to provide a quick little synopsis of what that session entails. In the session, we discussed and dove into shared clinical decision making and what does that mean. And we talked about the fact that this is an evolution in how we approach health care as more of a collaborative approach between patient and us as their clinicians.

This is a patient-centered care model that really combines with evidence-based recommendations and allows us to present those available options to approach any given medical concern our patient may have. And we can apply shared clinical decision-making to both screening and prevention, as well as disease management. The shared clinical decision-making does take into consideration the pros and cons of what we may be recommending for our patients.

We really try to weigh those risks versus benefits, and it can include an expanded decision-making, which may include non-medical considerations. For example, we talked about patient goals and wishes. It may incorporate some of their cultural or religious beliefs and gender, both the gender of the clinician as well as the patient may play a role here as well. It also talked about access, a geographic versus economic, and maybe some issues with insurance coverage.

We used shared clinical decision-making, and we modeled that with a few case studies. We talked about Justin, who's a 36-year-old male, recently single, who wanted to discuss HPV vaccination. We know we're busy in our practices, so we did bring in some options for resources that can both streamline this process for the clinician as well as the patient.

In particular, with regards to Justin, we talked about the advisory committee on immunization practices, the ACIP, which is updated yearly. It includes both adult and pediatric recommendations, adult starting at age 19 and older, and it is endorsed by multiple academies, including the CDC, American College of Physicians, My Academy, the American Academy of Family Physicians, and others.

You can access this at the CDC website (www.cdc.gov/vaccines/acip). We showed on this website how the ACIP has some shared clinical decision-making guidance for the clinicians and even there's PDF handouts that you can provide to your patient so they can educate themselves. It really demonstrated how we can utilize evidence-based medicine to provide those with appropriate education to assist patients in making these type of health care decisions.

We then moved on to Holly, who's a 45-year-old female who you might be seeing in your office for her annual well-women exam. Holly brought up questions about clinical breast exams and mammography-whether or not she should be getting this and when and how often. This is where we provided that caveat regarding medicine that medicine is not an exact science.

it is the art of medicine and we are practicing and we also talked about how guidelines change and not every organization and academies agree with each other. We modeled this by presenting recommendations from four different groups, the United States Preventative Services Task Force, the American Cancer Society, the American College of Obstetrics and Gynecologists, as well as the National Comprehensive Cancer Network. We provided a table that demonstrated how these organizations' guidelines may differ with regards to Holly in terms of when we start offering screening mammography and how often.

We also showed that sometimes our guidelines will change as new evidence becomes available. In fact, the United States Preventative Services Task Force has a draft recommendation from 2023 that is in the process of being finalized. (Editor's Note: On April 30, 2024, the USPSTF updated their guidelines, recommending that all women should start getting mammograms every other year beginning at age 40).

Instead of making it sort of an individual decision, a category C, between ages 40 to 49, they are now doing a recommendation B. That's in their draft recommendation. We did delve further into the United States Preventative Services Task Force and their grading system because it will be important as a clinician that we understand how these guidances come about.

And what do they mean by that "I" statement, which is known as insufficient evidence? So basically when the United States Preventive Services Task Force gives a recommendation of an "I" statement, this is really where we as a clinician can employ that shared clinical decision-making because they don't have necessarily enough guidance to really say "Yay" or "Nay" on a recommendation, but this is where patients' wishes can be brought into the discussion. and we can use the evidence that we do have to have that discussion.

We then talked about patient advocacy for the patient by the patient. What is a patient advocate? A patient advocate is a person or persons who really can help guide a patient in the healthcare process. They can help coordinate with scheduling appointments, testing, etc. work with insurance companies, medical entities, and help with that financial, legal, and even social supports. We, as their clinician, can be a patient advocate and often they look to us to advocate for them. They trust us and they really are looking for our guidance.

But we also emphasize how important it is for the patient to self-advocate because, at the end of the day, the patient is the one that will make the decision. How far do they want to go with their health care and their decisions and when maybe they've had enough?

So in summary during this session, we talked about shared clinical decision making as a collaborative approach between both the clinician and the patient, which follows evidence-based medical recommendations that really empowers those patients in making the best decisions for their health care needs.

We want to utilize available resources that can really streamline that education process of the patients and give them the necessary information to make an important decision. Patient advocates can aid these patients in understanding their diagnosis and the treatment options can help them navigate the insurance and care pathways and provide a source of advice and support.

Once again, clinicians should implement shared clinical decision-making, as well as advocate for those patients to empower them on their health care journey. So once again, thank you for participating. And if you didn't get the opportunity, I hope you are able to log on and get some pearls that you can take back to your practice.

Thank you.