Shared Decision Making in Healthcare: Results from the Salzburg Global Seminar

The setting is an 18th-century palace, Schloss Leopoldskron, and the adjoining Meierhof building. This is the home of the Salzburg Global Seminar, an international institution that challenges current and future leaders to develop creative ideas and innovative strategies for solving universal problems. Located on the outskirts of Salzburg, Austria, and dating back to 1740, the palace is situated on a spacious, private estate with a spectacular view of the Alps. It has a colorful history. Mozart played there under the sponsorship of one the palace’s owners, Count Laktanz. In 1918 it was acquired by Max Reinhardt, a cofounder of the Salzburg Festival of music and drama. The grounds and interiors of Schloss Leopoldskron served as inspiration for many scenes in the movie The Sound of Music, with the palace’s Venetian Room, designed by Reinhardt, recreated in a studio to serve as the Von Trapp family ballroom.

Here, I was extremely fortunate to convene and participate with 58 people from 18 countries in December 2010 to discuss the role patients can and should play in healthcare decisions. This session, entitled “The Greatest Untapped Resource in Healthcare? Informing and Involving Patients in Decisions about Their Medical Care,” was the second in a series of seminars focusing on health and healthcare. The session was organized in collaboration with the Foundation for Informed Medical Decision Making (www.informedmedicaldecisions.org), a nonprofit organization based in the United States that works to ensure fully informed patients are active participants in decisions involving their healthcare. The seminar received support from the Wellcome Trust, Bupa, and Health Dialog.

The participants developed the Salzburg Statement on Shared Decision Making, which was released world wide on February 7, 2011, in many languages, including English, German, Spanish, Hindi, Mandarin, Portuguese, Dutch, French, Cantonese, Greek, Albanian, Macedonian, Farsi, Serbian, and Bulgarian. The statement also was published in the British Medical Journal. The consensus statement (Sidebar) calls on patients and clinicians to work together to be coproducers of health.

The Salzburg Global Seminar is a nongovernmental organization that brings together experts and imaginative thinkers from diverse cultures, institutions, backgrounds, and experiences to address issues that pre sent a global concern. Last winter, Peg Ford, a patient advocate and one of our editorial board members, was invited to participate in a Salzburg Global Seminar to contemplate the importance of patients’ involvement in healthcare decision making. Ms Ford was joined by a group of 57 other experts in healthcare. On behalf of all of us at The Oncology Nurse-APN/PA, congratulations to Ms Ford on this honor. It is our pleasure to present the following report from Ms Ford regarding this extraordinary experience.

The Salzburg Statement on Shared Decision Making

We call on clinicians to:

• Recognize that they have an ethical imperative to share important decisions with patients
• Stimulate a two-way flow of information and encourage patients to ask questions, explain their circumstances, and express their personal preferences
• Provide accurate information about options and the uncertainties, benefits, and harms of treatment in line with best practice for risk communication
• Tailor information to individual patient needs and allow them sufficient time to consider their options
• Acknowledge that most decisions do not have to be taken immediately, and give patients and their families the resources and help to reach decisions.

We call on clinicians, researchers, editors, journalists, and others to:

• Ensure that the information they provide is clear, evidence-based, and up to date, and that conflicts of interest are declared. We call on patients to: • Speak up about their concerns, questions, and what’s important to them • Recognize that they have a right to be equal participants in their care • Seek and use high-quality health information.

We call on policymakers to:

• Adopt policies that encourage shared decision making, including its mea surement, as a stimulus for improvement
• Amend informed consent laws to support the development of skills and tools for shared decision making.

Why?

Much of the care patients receive is based on the ability and readiness of individual clinicians to provide it, rather than on widely agreed standards of best practice or patients’ preferences for treatment.

Clinicians are often slow to recognize the extent to which patients wish to be involved in understanding their health problems, in knowing the options available to them, and in making decisions that take account of their personal preferences.

Many patients and their families find it difficult to take an active part in healthcare decisions. Some lack the confidence to question health professionals. Many have only a limited understanding about health and its determinants and do not know where to find information that is clear, trustworthy, and easy to understand.

Salzburg Global Seminar: The Greatest Untapped Resource in Healthcare? Informing and Involving Patients in Decisions about Their Medical Care. 12-17 December 2010 (Session 477). Further details: www.SalzburgGlobal.org/go/477.