Shared Decision Making Flashcards
What is shared decision making?
Process of engaging clients in process of deciding diagnosis, treatment or follow-up
When more than one medically reasonable option is available
Useful for preference-sensitive decisions when there is no ‘best strategy’
Facts provided by vet, values from patient
What steps are involved in shared decision making?
1 - Define or explain problem
2 - Present options
○ Be neutral, not leading
○ Appropriate to client’s level of understanding
3 - Discuss pros and cons
○ Benefits
○ Risks
○ Costs
4 - Assess clients’ values or preferences
5 - Discuss client ability or self-efficacy
○ Practicalities
6 - Provide information or recommendations
7 - Check or clarify understanding
8 - Make or explicitly defer decision
○ Thinking time
○ Talk to family
9 - Arrange follow-up
What owner considerations are there?
What options are available for treatment?
Rate and likelihood of return to normal function
Aftercare required
Are they able to medicate, lift etc.
Costs
Time and money
Probability of complications
Are they prepared for additional cost etc if necessary?
Acceptability of euthanasia as a treatment option
sentimental/financial value of animal
Benefits of shared decision making
Decisions tailored to the individual client and patient
Informed consent
Greater client + vet satisfaction
Improved treatment adherence
Improved outcome for patient
Strengthens vet-client relationship
Fewer repeat consultations
Less likely to ask for second opinion
Complaints less likely
Cons of shared decision making
More time consuming
What is informed consent?
‘Informed consent can only be given by a client who has had the opportunity to consider a range of reasonable treatment options (including euthanasia), with associated fee estimates, and had the significance and main risks explained to them… (RCVS 2021:Section 11.2)
* … in a way that the client understands’
○ E.g. Explain any clinical terms
Full information provision
Understanding and free choice
