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EIP > Shared Decision Making > Flashcards

Shared Decision Making Flashcards

1
Q

True or false- Px’s need to make decisions about their health care

A

TRUE

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2
Q

True or false- Many Px’s find it difficult to take an active role in decision making about their health care

A

TRUE

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3
Q

What is the key in engaging Px’s in decision making

A

effective communication

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4
Q

What are the 3 things Px’s should know about each management option?

A
  • benefits
  • risks and harms
  • uncertainty
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5
Q

Patient-centred care involves 4 things:

1) treating Px’s with ___
2) responding ____ to px’s needs
3) Providing Px’s with ____
4) Focus on ___ rather than ___

A

1) treating Px’s with RESPECT and DIGNITY
2) responding QUICKLY to Px’s needs
3) Providing px’s with enough INFORMATION to make informed decisions
4) Focus on PATIENT rather than CONDITION

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6
Q

Where on the scale of paternalistic and informed Px does Patient-centred care sit?

A

between

  • paternalistic –> Dr makes choice
  • informed Px –> Px makes choice
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7
Q

What is the most difficult step in EBP?

A

incorporating Px values, preferences and circumstances

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8
Q

What helps Px’s make informed decision

A

communicating evidence with Px

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9
Q

True or false- shared decision making is not critical in EBP

A

FALSE

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10
Q

TRUE OR FALSE- Shared decision making is ethically important

A

TRUE

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11
Q

What tool can be used to help Px’s with shared decision making?

A

Decision Aids

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12
Q

What are Decision Aids?

A
  • tool that helps px’s with shared decision making
  • informs Px’s
  • info on benefits/harms/values
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13
Q

True or false- Decision Aids can help Px’s make decisions better aligned with their values

A

TRUE

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14
Q

What does shared decision making reduce?

A
  • over-diagnosis
  • over-treatment
  • inappropriate use of tests/treatments
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15
Q

True or false- shared decision making is a single step added to a consultation

A

FALSE- it is a process

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16
Q

True or false- shared decision making is provision of Px education

A

FALSE- a lot more to it

- bidirectional communication and establishing partnership with Px

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17
Q

True or false- shared decision making is giving a Px a decision aid

A

FALSE- a lot more to it

- tailored to Px needs and circumstances

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18
Q

What steps are involved in Shared Decision Making?

A
  • explaining problem and need for decision
  • inviting Px’s engagement
  • explaining options and benefits/harms of each
  • exploring Px’s values
  • Clarifying understanding and answering px questions
  • collaborative discussion
  • making or deferring decision
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19
Q

True or false- deferring a decision is a step in shared decision making

A

TRUE- can make or defer decision

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20
Q

How can you gauge the Px’s expectations about management of condition?

A

Ask e.g. ‘ what have you heard about or know about …?’

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21
Q

What information should be provided alongside discussing benefits and harms?

A

probability of each occurring (when known)

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22
Q

What are potential harms of a treatment option that are personal to Px?

A

cost
inconvenience
interference with daily roles
reduced quality of life

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23
Q

What is a method that can be used to ensure Px has understood you?

A

teach-back method

24
Q

True or false- duration of consult will be lengthened because of shared decision making?

A

FALSE - happens throughout consult too

25
Q

True or false- Px’s will be unsupported when making healthcare decisions?

A

FALSE- Px’s not forced to make decision by themselves

26
Q

True or false- not every Px wants to share decision making process with clinician

A

FALSE- evidence shows otherwise

27
Q

True or false- not every Px can participate in shared decision making

A

FALSE

- decrease inequity so engage vulnerable people

28
Q

Does engaging Px’s with shared decision making increase their anxiety?

A

NO

- decisional conflict is not the same as anxiety

29
Q

True or false- shared decision making is the same as informed consent?

A

FALSE

30
Q

Should what clinicians inform px’s about in terms of benefits, harms and options be determine by what a ‘reasonable Px’ deems important or by what a ‘group of clinicians’ deems important?

A

What a reasonable Px deems as important is more important in shared decision making than what clinicians think

31
Q

Can we assess the quality of decision aids?

A

YES- using IPDAS (international patient decision aid standards)

32
Q

What is the best way to communicate the following statistic –> “there is a 20% risk of a side effect”

A

WHAT NOT TO DO: “there is a 20% chance that you will have side effect with intervention”
- px can interpret as they will have side effect 20% of time

WHAT TO DO: “of every 100 Px’s having this intervention, 20 experience the side effect”

33
Q

What is the best way to communicate the following statistic –> “By having a screening test, your risk of dying from the disease is reduced by 50%”

A
  • large number can be misleading so Px thinks reduction in death is large
  • INSTEAD SAY: ““Your baseline risk of dying from the disease is 1 out of 1000. By undergoing the screening test, this is reduced by half, or to 1 out of 2000”
34
Q

Define probability:

A

Chance of event occurring b/w 0 and 1

can be %

35
Q

Types of probability:

A
  • single probability

- conditional probability

36
Q

What is single probability

A

20% chance you will have side effect

37
Q

What is conditional probability

A

probability of event given that another event has occurred

- e.g. if Px has disease, probability +ve screening test for disease is 90%

38
Q

Define odds ratio

A

odds or something being true in one group compared to another group

39
Q

Let’s say we find 10 myopes in a sample of 45 people

  • The odds of any one individual being a myope is:
  • The probability (or risk) of an individual being a myope is:
A
  • ODDS –> 10:35 (or 10 to 35 or 0.29 to 1)
    (denominator is remainder)
  • PROBABILITY –> 10/45 (or 0.22)
    (denominator is total)
40
Q

Are odds and risks the same?

A

NO- but often similar (esp. in rare case)

41
Q

How to calculate: Control Event Rare (CER)

A

probability of developing outcome for control group
CER=c/c+d
Outcome YES Outcome NO
Treatment A b
Control c d

42
Q

Experimental Event Rate (EER)

A

probability of developing outcome for experimental group
EER = a / (a+b)
Outcome YES Outcome NO
Treatment A b
Control c d

43
Q

Relative Risk (RR):

A 
ratio of (probability of developing outcome in treatment groups) / (probability of developing outcome in control group)
RR = EER/CER
44
Q

Absolute Risk Reduction (ARR):

A

ARR = CER-EER

difference in rates of adverse events b/w control and experimental groups

45
Q

Relative Risk Reduction (RRR):

A

RRR = (CER-EER)/CER

extent to which treatment reduces risk compared to no treatment

46
Q

Number needed to treat (NNT):

A

NNT = 1/ARR
= 1 / (CER-EER)

i. e. no of px’s needed to treat to prevent one adverse outcome
- ideally want 1 (every treated Px prevents adverse effect)
- usually >1

47
Q

Should we communicate probabilities to Px?

A

no- communicate natural frequencies

48
Q

What should we avoid communicating statistically to Px’s?

A

probabilities and percentages- can be misleading

49
Q

What statistics should we communicate with Px?

A
  • natural frequencies (e.g. 1 in 20)

- absolute risk reductions > relative risk reductions

50
Q

Is it better to communicate relative or absolute risk reduction?

A

absolute risk reduction

- relative can be misleading

51
Q

How can we avoid Px’s misinterpreting statistics?

A

communicate baseline

52
Q

Should we communicate number needed to treat?

A

NO- difficult to understand

53
Q

Words or numbers?

A

numbers (instead of very common, rare etc.)

54
Q

Should you present info in positive or negative manner?

A

Both

55
Q

Main considerations for format of communications with px?

A
  • Px preference
  • Px literacy level
  • Px cognitive ability / impairments
  • resource available
  • time

EIP (7 decks)

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