THE PATIENT-PHYSICIAN RELATIONSHIP Communicating Evidence for Participatory Decision Making

PHYSICIANS SHOULD CREATE COLlaborative partnerships with patients (and families) in which clinical decisions are made using the best available evidence, consistent with patients’ values, goals, and capabilities. However, this ideal is rarely achieved. Physicians typically spend less than 1 minute out of a 20-minute visit discussing treatment and planning. Informed decision making occurs in only 9% of outpatient office visits, and physicians ask patients if they have questions in less than half. Although patients generally want more information about their illnesses, they recall only a fraction of the information physicians transmit. Communicating evidence to patients haspractical, relational, andethicalgoals. Informed patients are more likely to participate actively in their care, make wiser decisions, come to a common understanding with their physicians, and adhere more fully to treatment. Communicating evidence can transform a physician-dominated relationship into one that is relationship-centered. Patients have a right to understand their illness,prognosis, andtreatmentoptions, regardlessofwhether theychoose toparticipate in decisions. Patients care about how evidence is presented. Elwyn et al published 2 studies in which focus groups of physician-educators and residents defined skills for shared decision making, including communicating evidence. These skills were used rarely. Participants suggested that the decision options be presented before eliciting the patient’s preferred role in the decision or determining the preferred formats for further discussion. The focus groups in the study by Ford et al included a va-