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?
Use explicit signposting - "3 important things to discus, first..."
Repeat and summarise to reinforce
Avoid jargon or explain terms
Use visual methods
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?
•Discuss the plan for next appointment or review if indicated.
•Safety netting- if your condition worsens seek medical review sooner
•Final check – Do you have any questions?
•Diabetes Specialist Nurse
•Retinopathy screening team
•Renal Medical Staff
•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!