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Flashcards in Providing Explanations and Shared Decision Making Deck (15)
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What are advantages of self management?

Patient takes responsibility and interest in their condition e.g. Diabetes

Encourages shared decision making and patient sets realistic goals for blood glucose control with advice from professionals.

Patient uses support from healthcare staff appropriately

Still attends regular review appointments e.g. podiatry, eye screening & makes appropriate use of services


What are the disadvantages of self management?

•Patient perception that they are expected to cope with their condition alone

•The condition or complications may be perceived by patient/families as less serious.

•Patient in denial may not be honest when answering questions re treatment concordance/compliance

•Monitoring of their condition takes over their life and can affect friends/family members if they adopt a sick-role.


What are the 4 key aims of explanation and planning?

1.Providing the correct amount and type of information

2.Aiding accurate recall and understanding

3.Achieving a shared understanding: incorporating the patient’s illness perspective

4.Planning: shared decision making


So when performing the explanation and planning, what is important when providing the correct amount and type of information?

Give comprehensive and appropriate inormation

Assess the individual patient's information needs

Neither overload or restrict information


How can we aid accurate recall and understanding?

Organise explanation

Use explicit signposting - "3 important things to discus, first..."

Repeat and summarise to reinforce

Avoid jargon or explain terms

Use visual methods

Check understanding


How do we achieve a shared understanding with the patient?

Whats the point?

The point in shared understanding:

Explanation has to relate to the patients perspective - you have to make explanations surrounding what is important to the patient

It encourages patient contribution



Pick up and respond to cues - verbal and non-verbal

Try to gather the patients beliefs, reactions and feelings



What is shared decision making?

Shared decision making (SDM) is the conversation that happens between a patient and their health professional to reach a healthcare choice together. This conversation needs patients and professionals to understand what is important to the other person when choosing a treatment.


How can we employ shared decision making?

•Share your thinking

•Involve the patient – offer suggestions or choices, if appropriate

•Explore management options

•Ascertain level of involvement the patient wishes

•Negotiate a mutually acceptable plan

•Check with patient again



Provide more information: Pros and cons - what are the patients views on these?

Take into account lifestyles, beleifs and cultural background

Encourage patient involvement - responsibility and self reliance

Explore other support options


Whem might shared decision making become difficult?

Sometimes patients want the doctor to make all the decisions

Patients desire for autonomy can vary considerably


During explanations: What should you do when the patient is angry or upset?

•remember it is the patient/relative who is angry or upset, not you

•be polite but firm

•acknowledge their feelings

•be willing to talk and listen – open questions

•create a calm and/or supportive atmosphere


Explanations – When the Patient is Angry or Upset

What should you not do?

•react to anger with anger

•take personal offence at anything that may be said

•interrupt or contradict the patient

•caution their choice of words

•make promises that cannot be kept


What are the things to consider when closing the consultation?

Forward Planning

•Discuss the plan for next appointment or review if indicated.

•Safety netting- if your condition worsens seek medical review sooner

Appropriate Closure

•Summarise briefly

•Final check – Do you have any questions?

•Thank you


Some MDT

•Hospital Consultant


•Diabetes Specialist Nurse

•Nurse Practitioner




•Retinopathy screening team

•Practice Nurse

•Junior Doctors

•Renal Medical Staff

•Vascular staff

•Ward Nurse

•Physician associate


•Occupational Therapist

•Social Worker

•Lab staff

•Specialist Midwife



•Give clear information and explanations to your patients

•Ensure patient understands the information given

•Shared decision making at an appropriate level for each individual

•MDT working improves patient care – remember to communicate within the team and between teams!