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Focus on treatment decisions: Doctor and patient should decide together

October 23, 2015

Doctor and patient decide together which treatment to perform--this ideal is now anchored in the Law on Patient Rights and the Professional Code for Physicians in Germany. Shared decision making, in which doctor and patient exchange knowledge concerning the patient's disease and its treatments, discuss treatment options, and jointly choose one, is the gold standard. This edition of Deutsches Ärzteblatt International, which focuses on patient involvement, contains two original articles investigating the following questions: Do patients benefit from shared decision making? Is treatment more effective as a result? How do physicians gain from training in shared decision making?

In their systematic review, Katarina Hauser et al. (Dtsch Arztebl Int 2015; 112: 665-71) investigate studies in which some patients took part in shared decision making, while the treatment decisions of others were made in the conventional way. They used disease-relevant endpoints in order to compare the efficacy of treatment in the two patient groups. Treatment outcomes were found to improve after shared decision making in just under half of the studies. However, the authors state that they were unable to reach a definite conclusion regarding shared decision making because it was only possible to evaluate a small number of papers: just 22 studies met the inclusion criteria.

Martin Härter et al. (Dtsch Arztebl Int 2015; 112: 672-9) conducted a randomized controlled trial to analyze whether physicians were better prepared for consultations on treatment decisions with their cancer patients after 12 hours of training in shared decision making, and whether the patients benefited as a result. Patients were interviewed immediately before and three months after their doctor-patient consultations, using a questionnaire which included questions concerning their confidence in and satisfaction with their treatment decisions. This revealed that patients of physicians who had been trained in shared decision making were no more confident in their decisions than those of physicians who had not. However, after training, the physicians' shared decision-making skills were better, and their patients had slightly lower scores for anxiety and depression. The authors point out that physicians participating in shared decision making training programs have many hurdles to overcome and therefore only 23 of the 900 originally contacted physicians completed the whole trial. They call for the promotion and funding of studies on shared decision-making training and evaluation.

Deutsches Aerzteblatt International

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