Shared Decision-Making in Acute Pain Services

Abstract

Purpose of review: The implementation of shared decision-making (SDM) in acute pain services (APS) is still in its infancies especially when compared to other medical fields.

Recent findings: Emerging evidence fosters the value of SDM in various acute care settings. We provide an overview of general SDM practices and possible advantages of incorporating such concepts in APS, point out barriers to SDM in this setting, present common patient decisions aids developed for APS and discuss opportunities for further development. Especially in the APS setting, patient-centred care is a key component for optimal patient outcome. SDM could be included into everyday clinical practice by using structured approaches such as the "seek, help, assess, reach, evaluate" (SHARE) approach, the 3 "MAking Good decisions In Collaboration"(MAGIC) questions, the "Benefits, Risks, Alternatives and doing Nothing"(BRAN) tool or the "the multifocal approach to sharing in shared decision-making"(MAPPIN'SDM) as guidance for participatory decision-making. Such tools aid in the development of a patient-clinician relationship beyond discharge after immediate relief of acute pain has been accomplished. Research addressing patient decision aids and their impact on patient-reported outcomes regarding shared decision-making, organizational barriers and new developments such as remote shared decision-making is needed to advance participatory decision-making in acute pain services.

Keywords: Acute pain; Patient satisfaction; Patient-centred care; Shared decision-making.

Fig. 1

This figure illustrates the influencing factors for patient-centred care or more specifically shared decision-making (SDM) in the acute pain service (APS) setting. The patient–physician relationship is based on a mutual conversation to develop a common ground for the decision-making (represented by the hands shaking). The tools that may aid patients and physicians in reaching a consensus are depicted in the text red and blue boxes. Outside of this dyad are restrictions due to organizational conditions (e.g. lack of quiet rooms), discordant ideological view and roles (e.g. seeing physician as prestigious people), cultural and leadership conflicts with SDM (e.g. a reward culture based on the amount of patients seen or the amount of interventions performed), time and cost constraints that need to be changed to create suitable conditions for SDM in APS. BRAN, Benefits, Risks, Alternatives and doing Nothing; MAPPIN’SDM, multifocal approach to sharing in shared decision-making; PDA, patient decision aid; SHARE, seek, help, assess, reach, evaluate