Shared Decision Making in Dermatology
SDM occurs when providers and patients come together to make decisions, which must involve at least 2 reasonably equivalent options.
Dr. Carrie Coughlin, MPHS, Associate Professor, Dermatology and Pediatrics, Director, Section of Pediatric Dermatology, Director, Pediatric Dermatology Fellowship, Division of Dermatology, Departments of Medicine and Pediatrics, Washington University School of Medicine/St. Louis Children's Hospital
October 2024
Dr. Carrie Coughlin presented information about shared decision making (SDM) for dermatologists.
First, Dr. Coughlin provided an overview of SDM. SDM occurs when providers and patients come together to make decisions. The decision must involve at least two reasonably equivalent options. Clinicians must clearly communicate the options and elicit patient and/or family preferences.
The benefits of SDM include reduced decisional conflict, increased patient knowledge, and decreased decisional regret. Dr. Coughlin noted that SDM can enable patients and providers to make the most appropriate choice, potentially leading to increased patient satisfaction. While SDM can extend a clinical encounter, it may decrease post-encounter concerns and follow-up.
Second, Dr. Coughlin shared tips to incorporate SDM into dermatology practice. Providers need training, time, and support to effectively engage in SDM. Dr. Coughlin noted that residents are evaluated on SDM. Providers need to consider patient and family health literacy and prior experiences that may impact their choices and outcomes. Decision support tools facilitate SDM by helping patients and families learn about their options, so they can arrive at clinical encounters more informed and ready to actively participate in decision making.
Dr. Coughlin shared examples of decision support tools, including an online decision tool for psoriasis treatment, an “Option Grid” table for whether to undergo a completion lymphadenectomy for patients with melanoma, and decision cards for vitiligo treatment.
Third, Dr. Coughlin described her work to develop a decision aid for families of children with congenital melanocytic nevi (CMN). The project is called “Choice Help: Optimizing Outcomes by Supporting Encounters for children with Congenital Melanocytic Nevi” (CHOOSE CMN). The research is primarily qualitative, based on semi-structured interviews. Patients and families were asked about their experiences living with CMN, their preferences for care, and roadblocks they encountered during care. The interviews were recorded, transcribed, coded for themes, and analyzed based on themes. Common themes that emerged became the basis of the decision aid Dr. Coughlin developed. The decision aid is currently in a pilot phase. It is supported by an advisory board comprised of both a patient representative and providers.
Dr. Coughlin shared takeaways from her research to date. She emphasized that patient and family voices need to be heard both in the literature and at the office. The interviews show the importance of early decision-making and areas for clinician improvement. As part of her research, Dr. Coughlin interviewed clinicians and shared that the process re-energized her work as a physician.
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