Lecture 8 - Decisional Support Flashcards
(26 cards)
What is meant by silent misdiagnosis?
Preference Misdiagnosis - caused by health care providers assuming they know know them without engaging in conversations about them.
What are the three steps of accurately determining patient preferences?
Adopt a mindset of scientific detachment - avoid bias
Use data to form a provision diagnosis - gather information from patient populations
Engage the patient in shared decision making - ongoing conversation involving the team
What are the consequences of preference diagnosis?
Unwanted treatments or missed opportunities for patients to receive care that aligns with their values
Contributes to wasteful healthcare spending
Creates disparity in healthcare delivery, as different populations may have varying levels of access to shared decision making.
What policy modifications can prevent preference misdiagnosis?
Data collection to better predict preferences
Shared Decision Making Tools
Addressing preference misdiagnosis
What is shared decision making?
A process by which decisions are made by the patient (+family) and the clinician using the best available evidence and patients informed preferences
Decision to be made <–> Info exchange <–> Values/preferences
What is the crux of patient-centred care, according to Weston (2001)?
Shared Decision-Making
What are the three main concepts in the Ottawa Decision Support Framework?
Decisional Needs
Decision Support
Decisional Outcomes
Decisional needs - can be met with decision support - quality of support can affect decisional outcome
What are some examples of decisional needs, as outlined in the ODSF?
Difficult timing, type of decision
Unreceptive decisional stage
Decisional conflict
Inadequate knowledge and unrealistic expectation
Unclear values
Inadequate support
Personal + clinical needs
What are the steps of providing decision support, as outlined by the ODSF?
- Establish rapport
- Clarify/explore decision and invite participants
- Assess needs
- Address needs with tailored support
How can decisional outcomes be assessed, according to the ODSF?
Assess quality of decision - should be informed and values-based
Assess quality of decision making process - reduced needs
Impact - continuation of chosen outcome, appropriate use of health services
How does patient education differ from decision support interventions?
Both can involve information about the clinic problem and the experience of others
However, decisional support also involves options and outcomes, outcome probability, explicit clarification of values, guidance of steps in decisional support and considers the role of others is decision making
Compared to usual care, patient decision aids have found…
To improve decision-making quality with increased knowledge, risk perception, and match between values and choices
Improve decision making process
How does supported decision making reduce health inequities?
Increases knowledge, decision self-efficacy, informed choice, and patient participation among disadvantages groups
(Durand et al.)
What are key challenges at the patient level in SDM?
Lack of knowledge, emotional stress, health literacy issues
What are key challenges at the provider level in SDM?
Time constraints, biases, unclear risk communication
What are key challenges at the interpersonal level in SDM?
Power imbalance, trust issues, language barriers
What are key challenges at the organizational level in SDM?
Lack of decisional aids, workflow pressure, limited collaboration
What are key challenges at the system level is SDM?
Policy gaps, financial constraints, attitudes
What are decision aids?
Pamphlets, videos, and digital tools that can provide information
What are different models of decision coaching?
Value clarification exercises, question prompt list, one-on-one coaching sessions
What are the roles of healthcare providers in decisional support?
Share information
Listen actively
Guide decision-making by encouraging exploration of choices
Support patient autonomy
Patient knowledge is key in measuring a good decision. How can it be assessed?
Post-decision surveys, comprehension tests, decisional aids
Value alignment is key in measuring a good decision. How can it be assessed?
Value clarification exercises, patient self-awareness
Decision confidence is key in measuring a good decision. How can it be assessed?
Decision conflict scale (DCS)
Confidence rating scales
