Patient engagement and shared decision-making: What do they look like in neurology practice?

Abstract

Neurology is inherently patient-centered given that clinical uncertainty is common, forcing physicians, patients, and families to partner on treatment approach. An increasing emphasis on patient-centered care, patient engagement, and shared decision-making (SDM) in health care provides neurologists with an opportunity to reassess current clinical approaches to decision-making. Such assessment is not simply theoretical but has clear practice implications, with patients indicating a desire for SDM and calls for reimbursement to be tied to demonstration of SDM in practice. We present a framework for how neurologists enhance patient-centered practice by (1) eliciting patients' values and goals, (2) targeting discussion of clinical options to those values and goals, and (3) partnering with patients to make individualized decisions. We also highlight resources that facilitate SDM and examples of SDM in neurology clinical practice.

Figure. Framework for patient engagement in clinical encounters

This framework for patient engagement and shared decision-making (SDM) in clinical visits shows patients at the top providing overall guidance, supported by carepartners and caregivers when relevant. Patients' values (blue) inform their goals (green) and both inform evidence-based discussions of health care options (e.g., tests, treatments) and decisions regarding the best options to achieve their goals. The 3 steps for patient engagement and SDM are outlined (boxes), with each step requiring participation by both physicians and patients. In neurology, this process most commonly occurs in the setting of clinical uncertainty, but it is relevant in situations with clinical certainty as well.