Advice From Heather Zacker on Optimizing Shared Decision-Making

In order to develop shared decision-making, physicians must build trusting relationships with patients and be mindful of cultural biases, according to Heather Zacker, MS, senior director of Care Alliances of Joslin Innovation at Joslin Diabetes Center. She also encouraged practices to develop a unified direction to ensure incentives are aligned for the entire care team.

Transcript (slightly modified)

Shared decision making, of course, has the patient at the center, and so what does that mean? On the one hand it means that the patient is empowered to make all the decisions, right, the providers are just there to empower the patient and inform the patient. But what’s really important to remember is that providing information does not equal communication.

So when you work with patients of diverse backgrounds, of different ethnic groups, et cetera, it’s really important to think about what might the cultural biases be, and it’s also really important to think, what’s kind of below the surface? So there might be behaviors or responses to questions that reflect or mask a deeper value system. I think it’s incumbent upon the provider to get to know the patient and develop that trust and that relationship, so that the shared decision-making is truly shared decision-making.

The other piece of it is the idea and concept that it’s important to bring all of the players and all of the team members who might have something to do with the patient into the same framework, somehow, through communication and shared goals. That is far tougher than it looks. What does that piece mean?

I think in a way that piece means that the infrastructure and the system and the incentives have to all be working in concert to provide a sort of alignment and shared direction. So you could have people with the best intentions, working at the top of their license, each doing their job, but if the system is set up for that to be siloed and not to have the transitions work and not to have the incentives aligned, then the shared decision-making will not be optimized.