Letters to the Editor
STEPS Approach Allows Patient to Participate in Decision Making
Am Fam Physician. 2011 Jan 1;83(1):8.
to the editor: It was with great pleasure that I read the article by Mr. Pegler and Mr. Underhill. As an educator of future family physicians and pharmacists, I have been using the STEPS (safety, tolerability, effectiveness, price, and simplicity) approach to teach about new drugs for some time. I use this structure to teach students how to assess a patient's current or potential drug therapy, and to discuss risks versus benefits of drug therapy options by replacing “price” with “patient preference,” which still includes the cost of the drug. When used in this manner, the STEPS approach helps to inform the shared medical decision-making process.1 For example, when discussing options to treat a patient with newly diagnosed hypercholesterolemia, a physician would review the known safety and tolerability (risks) data and patient-oriented effectiveness (benefits) data for a given medication in a nonjudgmental, nonbiased manner. From this point, the physician may put into context the patient's baseline risk of cardiovascular disease and the benefit expected from the medication (i.e., absolute risk reduction), and solicit the patient's preference about starting the drug or attempting therapeutic lifestyle modifications (simplicity).
By employing the STEPS approach in this way, the physician fulfills several key needs to enable patient participation in medical decision making: patients' need to be adequately informed; physicians' explicit encouragement of patient participation; appreciation of the patient's responsibility/right to take an active role in decision making; and awareness of choice.2 Although not all patients prefer to take an active role in the decision-making process, for those who do, applying the STEPS approach is one way to attain patient satisfaction with the process and enhance the therapeutic relationship.
Author disclosure: Nothing to disclose.
1. McNutt RA. Shared medical decision making: problems, process, progress. JAMA. 2004;292(20):2516–2518.
2. Fraenkel L, McGraw S. What are the essential elements to enable patient participation in medical decision making? J Gen Intern Med. 2007;22(5):614–619.
Send letters to email@example.com, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680. Include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.
Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the AAFP permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.
This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.
Copyright © 2011 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact firstname.lastname@example.org for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions