Digital Tools and Shared Decision-Making

Effective healthcare is shaped around good communication between a doctor and their patient. It requires honesty of a patient to detail their health concerns, and a receptiveness of physicians to meet individual needs. However, historically this relationship was paternalistic, dominated by the physician rather than a mutual participation. This often left little consideration for the structural barriers facing patients outside the doctor’s office.

In the 1980’s began in medical culture a shift towards a model of shared decision-making, where a patient and their providers discuss risks and benefits of different treatment options, reveal preferences, and jointly make a decision regarding treatment. The model has gained great support for empowering patients and improving outcomes.

This approach is especially important for patients with opioid use disorders, who often face stigma and rigid treatment plans, leading to low patient retention rates. Despite the availability of effective treatments, the U.S. has over 100,000 overdose deaths annually. Ruth Jeminiwa, PhD, assistant professor in the Department of Pharmacy Practice, is hoping to empower this patient population through digital heath tools that can promote more collaborative interventions.

Tell us about your research.

My research focuses on understanding preferences of people living with opioid disorder to promote shared decision-making and other patient-centric treatment policies in the care of this population. I am particularly focused on pregnant women with opioid use disorder, a patient population that has quadrupled since 1999. These women often face added stigma and punitive measures from child welfare and criminal justice systems – that includes having their child removed from their care, which has a cascading effect on the mental and physical health of the mother and the child.

What led you to your current research path?

Prior to becoming a researcher, my background was in web development and pharmacy. As a pharmacist I provided care to people with all types of conditions, including those with substance use disorders. I observed that these patients don’t receive fair treatment compared to those with other kinds of chronic conditions like hypertension. There are misconceptions around substance use disorders, which leads to shaming and judgement. Family members might not know how to best support their loved ones.

Even clinicians can hold bias, which may hinder their attitude towards patients and their communication about treatment. Sometimes patients might not even know why they are on a particular treatment and feel like their doctor is not invested in sharing that information, so they become disengaged. It is also important to consider that not all patients have agency in their treatment decisions. Some patients may be seeking to escape a violent situation, some may have a court order for treatment, and some may be concerned about losing custody of their children.

Getting a glimpse of patients’ experience, I felt like I could do something to help. My background in web development created an awareness of the use of digital products in improving healthcare. I wondered if I could blend my experience in technology and pharmacy to improve patient care.

What pushed you to make that transition from pharmacy to research?

I joined a PhD program and when I discussed my interest in technology and healthcare with my advisor, he encouraged me to pursue a research path with the foresight that digital health interventions would play a critical role in healthcare. I’m so grateful he gave me that push – with the shift to telehealth we’ve seen throughout the pandemic, there is a growing need to understand how to best implement digital tools and wearables which may be used for remote monitoring of different patient health information.

I began researching how digital health tools can impact patient behavior and outcomes. I learned more about the doctor-patient relationship and the imbalances that can hamper the transparent exchange of information around treatment. For instance, I studied asthma patients, a population in which treatment adherence is generally low. We found that patients did not hold the same beliefs as their care healthcare providers concerning their asthma or medication use which contributed to intentionally skipping some doses. This underscored to me the role of shared decision-making in educating the patients and understanding their preferences. I learned that when patients are more engaged with care and have shared decisions with their clinicians, then they’re more likely to stick with their treatment plan.

We also found that digital health interventions can improve treatment adherence by encouraging patients to track their medication use and provide “push” reminders. This experience showed me how digital tools promote shared decision-making.