22 - Decision Making Flashcards
What are the three types of consultation styles in medical decision making?
Paternalism - Clinician Centered Approach
Autonomous - Patient Directed (Patient=consumer)
Shared Decision Making
Describe Paternalism as an approach to consultation styles in medical decision making
Clinician is;
- The expert
- Protects patient from disturbing information
- Takes away the burden of decision-making
- Projects confidence and care
- Clinician makes the decision in patient’s best interest
Describe the autonomous approach to consultation styles in medical decision making
Clinician;
- Tells patient all the relevant information
- Is available to answer patient’s questions
- Does not make a recommendation
- Allows patient to reach his/her own decisions
Describe the shared decision-making approach to medical decision making
Collaborative process between clinician and patient to make informed, value-sensitive decisions that both agree upon
Patients and clinicians have different but equally valuable perspectives and roles within the medical encounter
Both are looked at as experts
- Patient always has last word.
No one accepted “gold standard” definition of SDM
Approaches often similar but have different names/stages/focus
Describe the shared decision-making framework (Charles, 1997)
Pioneering model of SDM
Most widely cited model of SDM
An encounter in which both clinician and patient;
- Share Information (Information Exchange)
- Mutually Deliberate on Treatment Options Process (Deliberation)
- Choose a Treatment to Implement (Decision)
Describe the shared decision-making model for clinical practice (Elwyn, 2012)
Provides guidance about how to accomplish SDM in routine clinical practice
3-step model
- CHOICE talk; introducing choice; does not have to occur during a face-to-face consultation (email, letter, phone call)
- OPTION talk; describing options
- DECISION talk; helping patients explore preferences and make decisions
Underpinned by the process of deliberation
- An ongoing and progressive process; may be repeated over time
- May include use of decision support tools and discussions with others
When should shared decision-making be used?
One size does NOT fit all -> patient preferences vary
BUT particularly appropriate in PREFERENCE-SENSITIVE SCENARIOS, when:
- Treatment outcomes are uncertain
- Quality of life may be affected
- Patient values determine the best outcome
What is shared decision-making demonstrated to be effective at?
increased;
- Overall satisfaction with their care
- Satisfaction with their doctor-patient relationship
- Satisfaction with the decision-making process
- Knowledge
- Quality of life
- Treatment adherence
What are some patient barriers experienced during shared decision-making?
- Conforming to social expectations of doctor/patient roles
- Emotionally vulnerable and emotional, possibly feeling powerless
- Lack a medical vocabulary
What are some clinician barriers experienced during shared decision-making?
Not an easy task for the health professional
Most NOT trained in SDM (particularly in Australia)
Common Misconceptions/myths
- Patients will feel unsupported when making decisions
- It will lead to longer consultations
- It will make patients more anxious
What are the three decision making interventions and strategies?
- coaching patients to ask questions
- question-prompt lists
- decision aids
Describe coaching patients to ask questions
- What are my options?
- What are the possible benefits and harms of these options?
- How likely are the benefits and harms to each option occur?
Designed to prompt physicians to provide minimum information that patients need to make informed decision.
Dr gave more info, patients more likely share in decision-making
Describe Question-prompt lists
Provide a list of common questions patients may want to ask
Patient/family tick relevant questions and add their own
Increases likelihood of asking difficult questions
More effective with Dr’s endorsement
Describe Decision-Aids
Inform (provide evidence about condition and all options)
Clarify Values (explore patient experiences, ask which benefits/harms matter most)
Support Process (guide in steps in deliberation, provide worksheet)
Optimal format depends
They are effective
What are decision-aids effecting at improving?
- Improve knowledge of screening/treatment options
- Facilitate more realistic and accurate expectations of possible benefits and harms
- Facilitate choices that are more consistent with patients’ values
- Increase active participation in decision-making
- Improve doctor-patient communication
- Reduce overuse of major elective surgeries, PSA (prostate cancer) screening, and the choice to use HTR (menopausal hormones)
