Lillebaelt Hospital, Vejle; The Danish Cancer Society, Copenhagen; Design School Kolding, Kolding, Denmark; University of Oxford, Oxford, United Kingdom; Coalition to Transform Advanced Care, Washington, DC; Advanced Care Innovation Strategies, Forestville, CA; Texas A&M University, College Station, TX; and Institute for Healthcare Improvement, Cambridge, MA DOI: https://doi.org/10.1200/JOP. 18.00019 Lessons in Integrating Shared Decision-Making Into Cancer Care Karina Dahl Steffensen, Mette Vinter, Dorthe Cr¨ uger, Kathrina Dankl, Angela Coulter, Brad Stuart, and Leonard L. Berry Abstract The benefits of shared decision-making (SDM) in health care delivery are well documented, but implementing SDM at the institutional level is challenging, particularly when patients have complex illnesses and care needs, as in cancer. Denmark’s Lillebaelt Hospital, in creating The Patient’s Cancer Hospital in Vejle, has learned key lessons in implementing SDM so that the organization’s culture is actually being transformed. In short, SDM is becoming part of the fabric of care, not a mere add-on to it. Specifically, the hospital chose and structured its leadership to ensure that SDM is constantly championed. It organized multiple demonstration projects focused on use of decision aids, patient- reported outcome measures, and better communication tools and practices. It designed programs to train clinicians in the art of doctor-patient communication. It used research evidence to inform development of the decision aids that its clinicians use with their patients. And it rigorously measured SDM performance in an ongoing fashion so that progress could be tracked and refined to ensure continuous improvement. Initial data on the institution’s SDM initiatives from the Danish national annual survey of patients’ experiences show substantial progress, thereby motivating Lillebaelt to reassert its commitment to the effort, to share what it has learned, and to invite dialogue among all cancer care organizations as they seek to fully integrate SDM in daily clinical practice. Optimal care of patients with complex illness requires clinicians and patients to share several distinct types of information. Clinicians rely on medical evidence, clinical training, and experience; patients rely on self-knowledge—what matters most to them. 1,2 Neither party owns all the im- portant information. Shared knowledge, transmitted in both directions, 3 can pre- vent silent misdiagnoses, whereby patients are unaware of all options and probable outcomes and clinicians are unaware of patients’ circumstances and preferences. 4 Shared decision-making (SDM) is a collaborative process that allows patients and health care professionals to make care decisions together, taking into account the best scientific evidence available, as well as patients’ values, preferences, life situation, and willingness to know about disease process and prognosis. 2 SDM is a process in which health care decision-making is performed with the patients and not for the patients. SDM will not always lead a patient (or a patient’s family) and clinicians to agree. It is not a panacea; rather, it entails focused effort to combine medical and patient self-knowledge and evaluate avail- able alternatives in light of these perspec- tives. 1 For SDM to be relevant, multiple options must be available (ie, there must be a real choice). It is especially important in serious illnesses like cancer, for which treatment may cause particularly adverse effects or where evidence is insufficient to clearly inform decision-making. 5 Copyright © 2018 by American Society of Clinical Oncology Volume 14 / Issue 4 / April 2018 n jop.ascopubs.org 229 Care Delivery Review Downloaded from ascopubs.org by 52.73.204.196 on May 16, 2022 from 052.073.204.196 Copyright © 2022 American Society of Clinical Oncology. All rights reserved.