Ch 22 Shared Devision Making For Periodontal Care Flashcards
Shared decision making
-is the “crux” of patient centered care
-collaborative process that recognizes the patients right to make decisions about their care after being fully informed about options
-patient is recognized as the best expert for judging the value of treatments
-appropriate where there is more than one reasonable option
Evidence based information
Systemic approach to clinical problem solving
-allows integration of best available research evidence with clinical expertise and patient values
Systemic review
Summarizes results of available carefully designed health care studies
-provides a high level of evidence on effectiveness of health care interventions
-involves significant others from cultural, social and age group
Systemic review characteristics
-develop a partnership with the patient
-establish patients preferences
-respond to patients ideas and expectation of therapy
-identify best choices for treatment after evaluating research
-allow the patient to reflect on alternative treatment
-develop the care plan in partnership
-document agreed upon personal care plan
Shared cared plan includes
Share information
Discuss and agree on goals
Jointly review plan
Record and share plan
Agree on follow up schedule
Jointly develop care plan
Two sources of expertise
The clinician is an expert in dental care
-patient is an expert on their own life circumstances and what matters most to them
Clinicians expertise
Diagnosis of condition
Disease etiology
Prognosis
Treatment options
Outcome probabilities
Patients expertise
Experience of condition
Circumstances
Attitude to risk
Values
Preferences
The clinical decision problem
Patients: unaware of trx or management options and outcomes
Clinicians: unaware of patients circumstances and preferences
LEADS TO poor decision quality
The share approach
Agency for healthcare research and quality (AHRQ) five step approach
(5 essential steps of shared decision making)
1. SEEK you pts participation
2. HELP your patient explore and compare treatment
3. ASSESS your pts values and preferences
4. REACH a decision with your patient
5. EVALUATE your pts decision
Patient decision aids
-informed resources like written materials, videos and web based tools
-improve knowledge of options
-allows patients to feel more informed and clear about what matters to them most
-have accurate expectations of benefits and harms
-elicit better participation in decision making
Typical information from patient decision aid
-description of condition and symptoms
-likely prognosis
-treatment and self management options Outcome
-what is known and what is not known from evidence
-most frequent complications of the treatment options
Reasonable patient standard states that
-a healthcare provider must disclose all information that a rational patient would want before making a choice to pursue or reject a treatment or procedure
-the healthcare provider who performs the treatment is ultimately responsible to inform the patient before consent
Legal claims against health care providers
Clinician did not perform treatment as decided upon
-clinician did not inform the patient properly or thoroughly about risks involved
-poor record keeping
Goals of informed consent
-provide an individual the opportunity to participate in decisions regarding treatment
Do not guarantee treatment outcomes to the patient
