Health 6

Question 1

What is paternalism

Answer 1

The docotr is the expert and they protect the patiwnt from a difficult decision

Question 2

What is patient directed or autonomous decision making

Answer 2

The doctor provides all the information and is available for questions but they make no recommendations; they let the patient do all the deciding.

Question 3

What is shared decision making (SDM)

Answer 3

Positioned in between paternal and patient directed
> it is collaborative
> it appreciates that both doctor and patient have a different level of expertise and have equally valuable perspectives

Question 4

What are teh clinicians areas of expertise?

Answer 4

Diagnosis
Disease aetiology
Prognosis
Treatment options
Outcome probabilities

Question 5

What are the patients areas of expertise?

Answer 5

Expertise of ilness
social circumstances
attitude
values
preferences

Question 6

What is the Charles shared decision making model?

Answer 6

It is the pioneering model and is most widely cited
> information exchange
> deliberation
> decision

doesn’t take into consideration the inclusion of many different doctors eg. encologist, health physician etc

Question 7

Legare (2011) Interprofessional Model of Shared decision model

Answer 7

Takes into consideration extra health professions in the model
> acknowledges the significant role of families and decision coaches

Question 8

Elwyn (2012) Shared decision making: a model for clinical practice

Answer 8

> Choice talk: introducing choices
options talk: describing options, decision-support tools
Decision talk: helping patients explore preferences and make decisions

Question 9

When should we use shared decision making?

Answer 9

> Preference sensitive outcomes
When it is a rare disease and the outcome is unknown
When patient values can help the outcome

Question 10

Is shared decison making effective?

Answer 10

> have higher overall satisfaction of care
> satisfaction of the dr-patient
> knowledge
> quality of life
> treatment adherence

Question 11

What are some patient barriers for shared decision model?

Answer 11

> conform to social expectations (older people may not be used to questioning authority etc)
if at an emotionally vulnerable stage they may feel powerless
if they lack a medical vocabulary

Question 12

What are some doctor barriers?

Answer 12

> it will blow out consultation times
make people more anxious
too complex for people with low IQ etc

Question 13

How can we coach patients to ask questions?

Answer 13

Ask the 3 questions

Question 14

What are the three questions patients are coached to ask?

Answer 14

What are my options?
What are the possible benefits and harms of these options?
How likely are the benefits and harms of each options to occur?

Question 15

What are decision aids?

Answer 15

Inform: provide evidence, all options, benefits and harms
Clarify Values: explore patient experiences
Support Process: provide worksheets, list of questions

Question 16

How do decision aids assist people?

Answer 16

> They improve knowledge
Facilitate more realistic and accurate expectations
increase active participation
reduce overuse of major elective surgeries (typically less conservative when involved in decision making process)

Question 17

What is a question prompt list?

Answer 17

A list of appropriate and common questions that patients may want to ask.

Question 18

How is a prompt list effective?

Answer 18

> It increases the likelihood of asking difficult questions

> More effective with doctors endorsement

Question 19

How are family members involved in decision making?

Answer 19

Very little research on it, but they are usually involved in the decision making process.

Unlike Dr/Patient it is across all stages of the decision process.

Question 20

What did Hobbs et al. find for family involvement in decision making?

Answer 20

Nearly 50% of people wanted shared decision-making with family.
> Higher for partners
> higher for ethnic backgrounds

Question 21

What are the decision making stages that involve family?

Answer 21

> Pre consultation preparation
> Information exchange
> Deliberation
> Decision
> Post decision reflection: a small number continue discussion after decision made - vital to confidence in treatment

Question 22

What are the attitudes towards family involvement?

Answer 22

Some feel that the patient should have priority.
End of life: feel that there should be an inclusion of family
Decision of fertility.

> End message: ask the patient and family and choose what suits them!