Compliance and Decision Making

Question 1

What are the top causes of death in the US?

Answer 1

Heart disease, cancer, CVA

Question 2

What are the actual causes of death in the US?

Answer 2

Tobacco, poor diet and physical inactivity, alcohol

Question 3

What are some things that can trigger behavior modification?

Answer 3

Birthday? Anniversary of a person’s death, media, mid-life crisis?

Question 4

Self-monitoring

Answer 4

objective/measurable goals

Question 5

Behavior modification categories (7)

Answer 5

Cue to action
Self-monitoring
Goal setting
Stimulus control
Social support
Rewards
Self-talk

Question 6

Stimulus control

Answer 6

knowing the situations that trigger behavior

Question 7

Cognitive dissonance

Answer 7

inconsistent thoughts and actions

Question 8

What is the bottom line for long-term follow up

Answer 8

a person is always at risk to do those behaviors again

Question 9

Behavioral change is not always enough, and medication needs to be added BUT

Answer 9

medication only works if the patient takes it and takes it properly

Question 10

What are common reasons for non-compliance?

Answer 10

Perceived cost/benefit
Polypharmacy
Logistics (can’t open pill bottles)
Co-mobidities (depression, addition)
Childhood and elderly (need support)
Health literacy
Beliefs

Question 11

Bottom line for non-compliance

Answer 11

don’t assume, ask

Question 12

Shared decision making is a process of _______ a course of ________ (including _______)

Answer 12

choosing, action, inaction

Question 13

Decision making capacity

Answer 13

Ability to utilities information about an illness and proposed treatment options to make a choice that is congruent with one’s own values and preferences

Question 14

Capacity can _____ over time

Answer 14

fluctuate

Question 15

Conditions with diminished capacity

Answer 15

dementia, such, TBI, end of life

Question 16

Elements of capacity

Answer 16

understanding
expression of choice
appreciation
reasoning

Question 17

Elements of capacity: understanding

Answer 17

to know the meaning of disease, treatment, options, risks

Question 18

elements of capacity: expression of choice

Answer 18

capability to express (verbally, written) choice

Question 19

elements of capacity: appreciation

Answer 19

Do they appreciate how are the “facts” are relevant to them

Question 20

elements of capacity: reasoning

Answer 20

can they relate their values/preferences to the choices to be made?

Question 21

The greater the potential risk from disease and/or treatment the

Answer 21

greater the need for capacity assessment

Question 22

Knowledge

Answer 22

do you know the risks and benefits of each option?

Question 23

Values

Answer 23

are you clear as to which benefits, and risks matter the most to you?

Question 24

Support

Answer 24

do you have enough support and advice to make a choice?

Question 25

certainty

Answer 25

Do you feel sure about the best choice for you?

Question 26

Decision support is a process of

Answer 26

assessing decisional needs, intervening to address individual needs, evaluating the progress and quality of decision making

Question 27

Quality decisions

Answer 27

informed congruent with personal values acted upon

Question 28

Presenting risk information: similar profile

Answer 28

probability of an outcome in people "like me" who experience the problem

Question 29

Presenting risk information: format

Answer 29

use quantitative, qualitative and graphic formats (100 faces) to enhance understanding

Question 30

Presenting risk information: framing

Answer 30

Risk message + positive messages improves message framing

Question 31

Helping interpret risk information? Risk of what?

Answer 31

getting a disease? dying?

Question 32

Helping interpret risk information? How big is the risk?

Answer 32

chance that your patient will experience the outcome

Question 33

Shared decision making is an integrative process between the patient and the clinician that

Answer 33

engages the patient in decision making provides the patient information and alternative treatments facilitates the incorporation of patient preferences and values into the plan