Origins of "What Matters": Shared Decision Making and Patient Engagement

In their landmark 2012 NEJM article outlining the importance of asking patients and families not “What’s the matter?” but, instead, “What matters to you?” Dr. Michael Barry and Susan Edgman-Levitan flipped the conversation to one that promoted engaging patients and families as partners in their care. Eight years later, operationalizing a shared decision making framework still proves to be challenging. One of the biggest barriers to success remains the fragmented health care system that doesn’t always value patients as equal partners.  


How to understand “What Matters”

Countless articles, research, and common sense tell us that engaged and educated patients and families are more informed, make more value-driven decisions, have better experiences, and improved outcomes. To achieve this value trifecta, patients’ preferences about their care have to be understood. Moreover, care teams must ask and listen to what patients and families tell them matters and incorporate the feedback into care delivery. 


Thousands of simple What Matters surveys have told us that patients and families identify these key themes across care experiences, age of the patient, and location:

  • Receiving excellent care
  • Communication across care teams
  • Feeling supported
  • Knowing that their time is valued
  • Being listened to


Interestingly, many of these same themes have been identified when care teams were asked “What Matters” to them, reinforcing that patients’ and care team preferences, outcomes, and experiences are emotionally and psychologically interrelated. Patients who have more ideal outcomes and experiences are known to be cared for by teams who are truly engaged, feel valued, supported, and listened to. Through “What Matters,” surveys and related-projects, employees experience less burnout, have increased connection to patients, and a shared mission with their team. 


Shared Decision Making-- The Pinnacle of Patient-Centered Care

Michael J. Barry, M.D., and Susan Edgman-Levitan, P.A.

NEJM March 1, 2012


https://www.nejm.org/doi/full/10.1056/NEJMp1109283


Posted on

May 22, 2020