Week 9 Flashcards
(20 cards)
1
Q
What is shared decision making?
A
- Collaborative process where clinicians and patients make health decisions together combining the clinicians expert knowledge with patients personal values
- Described as meeting of two experts: AHP is expert in the evidence, and the patient is an expert in what matters most
Allows people to play an active role in decisions about their health
- Described as meeting of two experts: AHP is expert in the evidence, and the patient is an expert in what matters most
2
Q
Key principles of SDM (PCTE)
A
Patient-centredness, collaboration and two-way communication, evidence and preferences
3
Q
Patient centeredness
A
- Places patient’s needs, goals and values at the centre of care
- Pinnacle of patient centred care
- Represents the highest standard of respecting patient autonomy
- Patients have the right to be fully informed and involved in decisions about their treatment
This is the ethically right thing to do and can even be viewed as an enhanced form of informed consent
4
Q
Collaboration and two-way communication
A
- Decisions are made jointly
- Clinicians contributes clean, unbiased evidence about the risks and benefits of each reasonable option and helps them understand these options in the context of the patients situation
- The patient contributes their preferences, concerns and life context
Both parties discuss and deliberate together to arrive at a decision
5
Q
Evidence and preferences
A
- Integrates best available evidence with patient values
- When there are multiple options, the goal is to find the option that best fits the patients informed preferences
This means that the clinician should explain the evidence and the patient should consider how each option aligns with them
- When there are multiple options, the goal is to find the option that best fits the patients informed preferences
6
Q
Roles in SDM
A
- The clinician shares medical expertise and evidence-based information about the condition and treatment options
- The clinician also uses communication skills to help clarify what is important to them
- The clinician must respect the patients goals and not pressure them toward a particular choice
- The patient shares their experience of the condition, their values, lifestyle and what outcomes they hope to achieve
- The patient asks questions and expresses any concerns or preferences
The caregiver or family member can support the patient by discussing options and sharing the caregivers perspective. In paediatric care or when an adult patient has impaired decision capacity
7
Q
Why us patient-centered care essential in AH
A
- Work closely with patients over multiple sessions
- Building partnership in decision making is crucial
- When they feel heard it can increase satisfaction and lead to better adherence to the care plan
- Shows that engaging patients in decisions can improve health outcomes
makes interventions more effective
8
Q
A shift from paternalism to partnership
A
- Paternalistic: The provider made decisions on behalf of the patient
- In moder practice, we recognise that a partnership yields better results
- The patients role is not passive, rather than simply consenting to what the clinician recommends
The patient is an active agent in planning their care
9
Q
Benefits of shared decision making
A
- Leads to better patient knowledge about their condition and options
- Tend to have a clearer understanding of pros and cons
- Improves patient satisfaction with the care process. People feel more confident and less anxious about decisions when they’ve been fully informed and their voice has been heard
- Lead to decisions that are more aligned with the patients values improving outcomes
- Enhances patient-clinician relationship and communication, patients are more likely to trust and communicate openly with clinicians who involve them in decisions
Upholds the principle of autonomy and informed consent
10
Q
Tools and approaches for SDM: Evidence based decision aids
A
- Evidence based tools designed to help patients understand their options and possible outcomes
- Present information about a health condition
They don’t tell them what to choose rather they help people deliberate
- Present information about a health condition
11
Q
What do decision aids look like
A
- Charts
- Web tool
- Option grid
- Calculators
- Videos
Worksheets
12
Q
Do decision aids really help
A
- Yes
- Improve quality decision making
- Better knowledge of their options
- More accurate expectations
Participate more in the decision making process
13
Q
Integrating patient values and clinical evidence
A
Three components: best evidence, clinical expertise, patient preferences to make decisions
14
Q
Steps in SDM
A
- Explain the Evidence: Discuss what the research guideline says about the patient’s condition and possible interventions
- Elicit patient preferences: Ask and listen to the patients perspective. What outcomes are they hoping for, do they have any concern, what matters most to you when considering these options, do you have any preferences
- Deliberate together: Use a tool or structures approach if helpful: SHARE, the three talk model. The core is to have an open dialogue: Consider the benefits, risks, alternatives and what happens if we do Nothing
15
Q
Free available SDM tools
A
- Ottawa personal decision guide: worksheet to work through difficult health decisions, clarify information, planning the next steps
- Option grid decision aids: comparison tables for specific decisions,
- NHS shared decision making resource: Patient decision aids for a variety of treatment and tests
Web-based tools and apps: specific to certain fields for decision aids
16
Q
Common barriers to SDM
A
- Time constraints: Time during appointments. How to address: Prioritise which decisions truly need a full SDM approach
- Patient factors (Health literacy, activation): Patients have trouble understanding medical information due to low health literacy or language barriers, may be unaccustomed to taking an active role. How to address: Use plain language and visual aids. Encourage input by asking open-ended questions about their life and goals.
- Clinician factors: Not all clinicians have training in how to do SDM, may fear it could lead to wrong decisions or conflict or an attitude of I know best. How to address: Training can help clinicians gain skills and confidence
System factors: Healthcare system, lack of decision aid availability, policies that favour certain treatments. Funding, limiting options. How to address: Advocation, be transparent about limitations
17
Q
Cultural considerations
A
- Culture can influence decision-making
- Be culturally sensitive
- Ask if there are other people they want involved
- Adapt the SDM process accordingly
- May be a shared decision making between the care team and family as a whole
Be aware of potential power dynamics
18
Q
Communication best practices
A
- Start by explicitly inviting the patient to participate
- Use empathetic listening
- Avoid medical jargon
- Present options fairly
- Check understanding and values frequently
Document the patients priorities
19
Q
Ethical considerations: Decisions that align with ethical principles
A
- Autonomy: Respecting the patients right to make informed choices about their own body and life
- Beneficence and non-maleficence: Weighing benefits and harms with the patient ensures we aim to do good for that individual and avoid harm
- Justice: Ensuring the patient has access to the information and support they need to decide
- SDM is essentially an enriched form of the informed consent process, ensures the patient truly understands and contributes to the decision
20
Q
Best practice tips recap
A
- Embrace SDM as a mindset
- Not every minor decision needs a lengthy process, so use clinical judgement on when to do a quick inform and check vs full SDM
- Utilise the tools and team around you - shared decision making can be supported by pamphlets, videos, decision coaches
Always circle back to what matters to the patient
