Health - Medical Decision Making Flashcards
Ilona begins with the case study of Lucy….she has been diagnosed with early breast cancer. She has to make numerous on-the-spot decisions including…
1, Type of Primary Treatment (masectomy OR lumpectomy and radiotherapy)
THESE HAVE THE SAME EFFECTIVENSS –> big breasted vs small breated –> longer vs shorter treatment –> chances of it coming back? Do they value their breasts or not? How will the treatment feel?
IF they choose masectomy…do they want breast reconstructon? (TIMING AND TYPE - Immediately? Delayed? Implant? Expander implant? Autologous?)
- Type of Adjuvant (insurance)
- Fertility options - would they like another child??
- Complementary therapy? Clinical trials?
In the case study of Lucy…she has to weigh up both ______ (health, pros and cons for survival) and _______ concerns.(keeping the family functioning). There are several treatment _____ _______ to consider (future children, sexuality, body image). Further, responsiveness to treatment, future risks and side effects are _______.
medical
personal
side-effects
uncertain
Consultation Styles and Medical Decision Making
Explain paternalism decision-making
- clinician is the expert
- protecting the patient from disturbing information
- takes away burden of decision making
- clinician makes the decision in the patient’s best interests.
Consultation Styles and Medical Decision Making
Explain Informed or patient-directed decision-making
- clinician tells patient all the relevant information and is available to answer any questions
- does not make a recommendation
- allows patient to reach their own decisions,.
Consultation Styles and Medical Decision Making
SDM is a _______ process between clinician and the patient to make ______ and value-_______ decisions that they _____ agree on. Both patient’s and clinician’s opinions are _______ valuable. Now, SDM is incorporated into _______.
collaborative
informed
sensitive
both
equally
legislation
Consultation Styles and Medical Decision Making
The Chalres et al. (1997 and 1999) SDM Framework is the most _____ cited. It describes the patient-clinician encounter as having 3 steps:
- _______ _______: the clinician shared all relevant information about available options and the patient provides information about their preferences, values, beliefs, etc
- _______: the doctor and patient _______ deliberate on treatment options. They _______ discuss preferences.
- _______: choosing a decision to implement. Both parties work towards reaching an ________ and action plan.
widely
information
exchange deliberation
mutually
interactively
decision
agreement
Consultation Styles and Medical Decision Making
Elywn at al (2012) SDM model for clinical practice provides guidance on how to accomplish SDM in ______ practice. This is a 3 step model:
- ______ talk - introduce choices
–> increases _______ of options
- ______ talk - describe options
–> leads to the development of _______ preferences.
- ______ talk - explore patient preferences and make decisions
–> Here the decision is made based on _______ preferences, and understanding of _____/______ of each option
Underpinning this whole process is ________.
It is an _______ and _________ process - may be repeated. It can include use of decision-support tools.
routine
choice
awareness
option
initial
decision
informed
costs/benefits
deliberation
ongoing
progressive
SDM should particularly be used in _________-________ scenarios.
Especially when:
- treatment outcomes are _______
- ______ of life may be affected
- the patient’s values will determine the _____ outcome (adherence to treatment, etc)
- when there are two treatments with ______ outcomes.
preference-sensitive
uncertain
quality
best
similar
SDM ADVANTAGES
Patients involved in SDM report increased…
- overall satisfaction with care
- satisfaction with doctor-patient relationship
- satisfaction with decision-making process
- quality of life
- knowledge
- treatment adherence
SDM DISADVANTAGES
What are the patient barriers to SDM?
- conforming to societal expectations of doctor/patient roles
- emotionally vulnerable, feel powerless, openness to suggestion
- lack of medical knowledge (do they know what prognosis means??)
–> some patients feel empowered by SDM, others feel abandoned.
Eg: autonomy/individualism is more important in western countries
SDM DISADVANTAGES
What are the clinician barriers to SDM?
- very difficult task for health professionals
- little training in SDM
- many myths among the profession (eg: patients feel unsupported, takes time, I already do this, too complex for patients, financially not everyone has a choice etc)
FAMILY INVOLVEMENT IN DECISION-MAKING
Family is usually involved in decisions to some capacity. An estimate of how much family is involved is ____%, yet just over a quarter (____%) desire little family input, so it depends on the individual. There is greater involvement of family when the patients are married, ______, older and from _____ or _______ background.
49
28
female
Asian
Hispanic
FAMILY INVOLVEMENT IN DECISION-MAKING
What additional stages did Laidsaar-Powell et al. (2015) add to the Charles et al. (1997; 1999) model of SDM? What other additions did it make to the main stages?
Added the “pre-consultation preparation” and “post-decision reflection” before and after the main SDM consultation. Before the consultation patients and families do lots of research. After the decision has been made, there is decisions-regret or satisfaction.
Within the main stages, it is important to note that these occur outside consultation as well - especially with conversations with family.
FAMILY INVOLVEMENT IN DECISION-MAKING
According to Australian Law, the patient has the ______ authority over a medical decision, and their wishes are paramount. It can be a challenge if family members are trying to ________ authority. SO family members have to be involved to the degree the patient wants. However, family involvement must been seen as _________ and some situations might require _____ family involvement. Eg: fertility. So overall, the approach as to be ______ based on patient and family needs. They need to _______ the situation appropriately. Unfortunately many family members see their role as a “______-___” for patients and may _______ their views. There are many benefits of family-involvement, including feeling more ______, having higher _______ in the decision, feeling ______ and sharing the _______.
ultimate
compromise
important
more
flexible
influence
back-up
censor
informed
confidence
supported
burden
