Health 6 Flashcards
What is paternalism
The docotr is the expert and they protect the patiwnt from a difficult decision
What is patient directed or autonomous decision making
The doctor provides all the information and is available for questions but they make no recommendations; they let the patient do all the deciding.
What is shared decision making (SDM)
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
What are teh clinicians areas of expertise?
Diagnosis Disease aetiology Prognosis Treatment options Outcome probabilities
What are the patients areas of expertise?
Expertise of ilness social circumstances attitude values preferences
What is the Charles shared decision making model?
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
Legare (2011) Interprofessional Model of Shared decision model
Takes into consideration extra health professions in the model
> acknowledges the significant role of families and decision coaches
Elwyn (2012) Shared decision making: a model for clinical practice
> Choice talk: introducing choices
options talk: describing options, decision-support tools
Decision talk: helping patients explore preferences and make decisions
When should we use shared decision making?
> Preference sensitive outcomes
When it is a rare disease and the outcome is unknown
When patient values can help the outcome
Is shared decison making effective?
> have higher overall satisfaction of care > satisfaction of the dr-patient > knowledge > quality of life > treatment adherence
What are some patient barriers for shared decision model?
> 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
What are some doctor barriers?
> it will blow out consultation times
make people more anxious
too complex for people with low IQ etc
How can we coach patients to ask questions?
Ask the 3 questions
What are the three questions patients are coached to ask?
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?
What are decision aids?
Inform: provide evidence, all options, benefits and harms
Clarify Values: explore patient experiences
Support Process: provide worksheets, list of questions
How do decision aids assist people?
> 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)
What is a question prompt list?
A list of appropriate and common questions that patients may want to ask.
How is a prompt list effective?
> It increases the likelihood of asking difficult questions
> More effective with doctors endorsement
How are family members involved in decision making?
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.
What did Hobbs et al. find for family involvement in decision making?
Nearly 50% of people wanted shared decision-making with family.
> Higher for partners
> higher for ethnic backgrounds
What are the decision making stages that involve family?
> Pre consultation preparation > Information exchange > Deliberation > Decision > Post decision reflection: a small number continue discussion after decision made - vital to confidence in treatment
What are the attitudes towards family involvement?
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!
