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By: Donna Dubuc. EVERYTHING YOU NEED TO KNOW ABOUT SHARED DECISION MAKING YOU LEARNED IN KINDERGARTEN. This Kindergarten Lesson is Conflict Free . I have no Conflict of Interest to disclose or report. Basic principles . Values and beliefs of shared decision making .
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I have no Conflict of Interest to disclose or report.
Values and beliefs of shared decision making
Shared decision making is used for preference sensitive situations, where there is no clear cut answer about which treatment option is best (equipoise).
Shared decision making is a two-way street. You must look at both sides before moving forward. The provider identifies the medical problem and lays out reasonable options. Patients identify and convey goals and concerns relevant to the decision.
Shared decision making is based on the belief that individual self-determination should be encouraged. Clinicians support autonomy by building good relationships and respecting patients’ competence and independence.
The responsibility for preference-sensitive decisions is shared through the creation of a partnership. With their provider’s support, patients won’t feel abandoned or like they have to decide on their own.
Using a decision support tool in an exam room encounter
Before offering information to patients, ask what they already know, ask “Have you read or heard anything about lung cancer screening?” Check for understanding. Is the pre-existing knowledge accurate?
In the exam room, when you offer a patient a decision aid allow for review time. Busy yourself with another task such as clinical note taking or email while the patient reads and considers the options.
When asking a patient to review a list of options or a decision support tool, give them a pen to make notes or circle the options they want to talk more about.
Know the options available to a patient and the risks and benefits of each. Have decision support tools ready.
When no existing decision tool exists, compile a list of options yourself.
Sticking together as patient and provider has psychological, social, and emotional factors that will influence deliberation dialogue. Glyn Elwyn breaks down this dialogue into choice talk, option talk, and decision talk.
A three step model for routine SDM by Glyn Elywn
Choice talk: Patients learn a choice exists, and that their personal preferences matter in making that choice
Option talk: Patients learn about treatment options in more detail to understand the different harms/benefits and consider the outcomes. Providers check for understanding .
Decision talk: Providers support patients in the exploration of what matters most to them. Providers elicit a preference. Check for certainty. Review decision.
Before moving from choice or option talk into decision talk, ask permission. “Shall we go on?” “Do you think you know how you feel about your options?” “Do you feel ready to make a decision?”
Offer an objective, unbiased presentation of options to consider. Review the pros and cons of these options. Describe options in practical terms.
Be clear about the pros and cons of different treatment options. Offer a neutral presentation of benefits and harms. Use easy-to-understand examples of risk. (Absolute instead of relative risk)
Use plain language. Low literacy and numeracy are obstacles to shared decision making. There are also cultural barriers. Make sure you meet people where they are at to form a partnership for shared decision making.
It is essential to understand what matters most to patients and support the process of deliberation. Decisions should be influenced by an exploration of preferences. Ask questions. Encourage a dialogue. Allow for pauses and silence. Listen carefully. Reflect back what is said. Confirm what you hear.
Know that informed patients have to spend time to consider their goals and concerns. It might not happen in one visit.
Patients are different from each other and their provider. Patients’ decisions may surprise you and be based on priorities you do not share. Respect every decision.
The basic application of shared decision making is for situations when there is no “best” solution. The right answer is what best reflects the patient’s priorities and values. It is also OK to decide not to decide.
Integrate shared decision making into routine care as part of existing workflow. Check for and resolve operational conflicts with existing systems, priorities, targets and incentives.
It is important to develop a positive attitude about involvingpatients in decisions.
Based on Glyn Elwyn, PhD et al. “Shared Decision Making: A Model for Clinical Practice. Journal” J Gen Intern Med 27(10):1361-7, 2012.
Don’t forget to wash your hands!