Trudy van der Weijden Professor of Implementation of Clinical Practice Guidelines
“Shared decision-making is not always possible in the consultation room”
Shared decision-making in the consultation room works in theory. “But it’s not always possible. You must be selective,” says Caphri’s Trudy van der Weijden. Nevertheless, this Professor of Implementation of Clinical Practice Guidelines will campaign for shared decision-making in the consultation room because, more often than not, it is successful.
Van der Weijden was campaigning for this even before her appointment as professor on 1 March. “The advantage of my appointment is that it opens doors for me and provides me with more opportunities. I’m very happy about that.” Looking back, she realises that her colleagues pushed her to succeed and for this she is grateful. “While my passion for research was the most important reason for becoming a professor, I would also like to be seen as a role model now. It’s important to me that other women follow my lead.”
As programme manager of Implementation of Evidence within Caphri, van der Weijden has been focusing on the development of scientifically sound guidelines and their practical translation for years. In doing so, she takes into account professionals, the system in which they function and the patient. She is also determined to pursue the principle of ‘best practices’. “Not all healthcare innovations can be contained within certain guidelines, but they have proven to be effective. It’s important that these best practices are being incorporated in more locations.”
Chair
As a new professor, van der Weijden intends on taking “as nuanced an approach as possible” to her work. This includes involving patients in the development of new guidelines. “Experience has shown that guidelines improve as a result of this.” As an example she cites the guidelines for rheumatoid arthritis patients. “The focus was only on treating joint inflammation, while patients also wanted to draw attention to their fatigue symptoms. These were not mentioned at all in the guidelines.”
The principle of shared decision-making plays an important role within this strategic position as chair—a position van der Weijden will hold for at least five years. There are several situations in which the best outcome is reached when the doctor and patient come to a collective decision. “Shared decision-making is always necessary when the patient’s behaviour influences their health, for example when lifestyle adjustments are required or with long-term medication use.” Shared decision-making should also be an option when prescribing treatments that have yet to be effectively proven or when taking medications that have serious side-effects.
Curative medicine
According to van der Weijden, shared decision-making plays an important role in both preventative and curative medicine. An increasing number of situations have arisen in curative medicine in which the doctor and patient can benefit from making collective decisions. “Just think of the myriad treatment options available to women with breast cancer,” van der Weijden says.
The literature has shown that shared decision-making encourages therapy compliance and stimulates people to make different choices. “Fewer people opt for elective surgery, for example.” The new professor is convinced that the principle of shared decision-making will be increasingly employed in the consultation room, even though market forces in the healthcare sector discourage doctors from taking the time to do so. “Eventually, well-informed patients will force their doctors to comply with this principle. We should facilitate shared decision-making by developing good web-based assistance options and training patient advocates to coach those patients interested in using these options.”
The sixth edition of the international shared decision-making conference will be held from 19 to 22 June 2011 in Maastricht.