Shared decision making

Shared decision making in healthcare is where you and your healthcare professional make important decisions together that relate to your health.

Decisions often need to be made in healthcare. For example, you might need to decide:

• whether to have a particular test
• which treatment to choose from a range of options
• whether to have treatment or wait and see how your condition progresses

If you are pregnant, you may need to make decisions such as:

• which model of pregnancy care you would like
• where to have your baby (such as at a hospital, birthing centre or at home)
• whether to have a vaginal or caesarean birth (C-section)
• which antenatal tests to have

In shared decision making, you and your doctor and midwife bring your perspectives to the discussion:

• Your doctor or midwife brings information and evidence about the benefits and disadvantages of different choices.
• You bring your values, goals, culture and circumstances.

This helps you make the choice that is right for you.

If you have a partner, you may involve them as well. When your birth partner is involved in shared decision making, it can help you make informed decisions and help you to feel more supported.

There are many benefits to shared decision making in maternity care.

Shared decision making is ethical

Shared decision making is an ethical way to choose something. It means that you are involved in decisions that concern you.

Taking part in decisions about your health can make you happier with the care you get. You might also be more motivated to stick to the treatment that you choose.

Shared decision making considers what's important to you

When you take part in the discussion, you're able to express what's important to you. You can choose the option that fits best with your values, desires and culture.

This is especially important with choices that you may have strong beliefs about. It's also important with choices where the medical evidence doesn't say clearly which is better or safer than the other.

You can also rule out options that might be difficult to access or too expensive for you.

Shared decision making gives you more knowledge

During shared decision making, your doctor and midwife will explain your choices. For each choice, they'll tell you about the risks and benefits involved and how might affect you. This will help you understand what to expect from the treatment you choose.

Sometimes, this may lead to you choosing a less invasive option. This may at times save unnecessary treatments and lower the costs involved.

As a patient in Australia, you can expect your treating team to respect your healthcare rights. The healthcare rights of all Australians are set out in the Australian Charter of Healthcare Rights. These rights apply to any healthcare you get, anywhere in Australia, including in:

• public hospitals
• private hospitals
• general practice
• the community

You have a right to:

• be treated with respect
• be involved in making decisions about your health and include anyone you want
• be informed about your health conditions and any tests or treatments you are offered
• receive help understanding this information, if you need it
• ask your healthcare team any questions you may have

Decision aids to help with informed choices

Your doctor or midwife might give you a decision aid. This is a paper or online resource that can help explain your options and get you to think about what's important to you.

If a decision aid is available for the choice you're considering, it can be very helpful.

You have a right to make decisions about your health without being pressured by others. This means that you are entitled to disagree with your doctor or midwife and choose not to have tests or treatments that they recommend.

Your doctor or midwife must respect your decision. They will be able to keep caring for you — you won't need to switch healthcare providers.

However, to make sure that you are making a fully informed decision, your doctor or midwife might:

• check that you understand why they recommend the treatment
• check that you understand and accept the risks of not having the treatment
• ask you about your reasons for disagreeing, such as your beliefs or culture
• discuss alternative options with you
• make a note about it in your medical record and ask you to sign it

Just like in any area of healthcare, you have a right to get a second opinion if you disagree with your doctor or midwife. Ask hospital staff to explain how to get a second opinion.

If you aren't satisfied with your healthcare, there are many people you can speak to, including:

• your doctor or midwife
• the health complaints agency or health department in your local state or territory
• the Australian Health Practitioner Regulation Agency (AHPRA), if you have a concern about the unsafe behaviour or practice of a registered health practitioner
• the National Health Practitioner Ombudsman

It's a good idea to ask your doctor or midwife for a debrief if you aren't sure about something that happened to you, especially during:

• labour
• birth
• in an emergency

This is an opportunity to ask questions after an event, so that you better understand what happened.

Learn more about making a healthcare complaint.

The Agency for Clinical Innovation has a consumer enablement guide on shared decision making.

You may find the following questions from Ask Share Know helpful when speaking to your doctor or midwife:

• What are my options? (One option will always be wait and watch.)
• What are the possible benefits and harms of those options?
• How likely are each benefit and harm to happen to me?

You can visit the Ask Share Know website for more information and questions to help you be involved in your health decisions.

If you want to know more about how decision aids can help, see these examples:

• screening tests for chromosomal problems
• unplanned pregnancy