Improving the Uptake of Clinical Preventive Services—Shared Decision-Making Can Help

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By Linda M. Harris, PhD,  Director, and Elizabeth Squire, MA, ORISE Fellow, Division of Health Communication and ehealth, Office of Disease Prevention and Health Promotion

shared decision-makingThe end of 2015 marks a time for reflection and new beginnings. You may have already started on your New Year’s resolutions. Here at the Office of Disease Prevention and Health Promotion (ODPHP) we hope that more adults who are not current on the recommended clinical preventive services have made it their New Year’s resolution to get up to date.

In the United States, only 25 percent of adults aged 50 to 64 years are current on recommended clinical preventive services and less than 50 percent of adults aged 65 years or older are up to date, according to the Centers for Disease Control and Prevention. Although many preventive services are available at no additional out-of-pocket cost beyond applicable insurance premiums, many patients, especially those with limited health literacy, may be unsure of what preventive services they need to receive to stay healthy.

Preventive care can sometimes be complex and confusing for patients because some clinical preventive services have more than one recommended screening option. One such example of a clinical preventive service with more than one screening recommendation is colon cancer screening. Colonoscopies are recommended at a much higher rate than the other screening recommendations for colon cancer. Patients who find the invasiveness of a colonoscopy or the lengthy prep for the procedure to be a barrier might forgo the test all together. If patients are presented with other screening options for colon cancer that require less prep or are less invasive, they might be more likely to follow through with the screening.

Adding to patient’s confusion surrounding screening options for preventive services is the ever changing landscape of medical science. The United States Preventive Services Task Force, an independent group of health professionals who provide recommendations on clinical preventive services, aims to update its clinical preventive service recommendations every five years. The updated recommendations for colon cancer screening are currently in progress and the draft recommendations include new information for providers.

Many patients, especially those with limited health literacy, might need help understanding which option is right for them. Patients must be able to understand health information that is presented to them when asked to make decisions that affect their health care. Shared decision-making is a collaborative effort between provider and patient that can help patients understand their options. The provider is the expert on the evidence-based screening and treatment options and the patient is the expert on their own preferences and values. Shared decision-making between providers and patients can help both feel confident and comfortable when making a decision between similar screening and treatment options.

Studies have shown that shared decision-making conversations and the use of decision aids can help to align health care options with patient preferences, engage patients in their care and potentially reduce health care costs. Unfortunately, shared decision-making is not used with patients often enough. In a study of over 3,000 patients 64% of the patients reported no past experience with provider-patient shared decision-making.

Shared decision-making can be applied to health care beyond clinical preventive services as well. Shared decision-making can be used with patients to discuss self-management of a long-term condition, treatment options, and more. A recent Cochrane review showed that interventions that aim to facilitate shared decision-making significantly reduce antibiotic prescribing for acute respiratory infections, such as an acute cough, middle ear infection, or sore throat. This finding could have far reaching implications in primary care and the fight against antibiotic resistance.

As the medical science around preventive care evolves, the decisions about clinical preventive services will continue to become more complex and personalized. To meet these 21st century demands, primary care teams of the future need to be prepared to engage with their patients in meaningful ways. Consumers also need tools and resources to help them understand health information. One such tool, myhealthfinder, is available on healthfinder.gov and uses health literacy principles to help patients understand what preventive services they need to stay healthy.

Learn more about shared decision-making:

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