HL1 - Dr-Patient Family Communication

Question 1

What do health psychologists do?

Answer 1

• Clinical setting - have special area of practice in coping and adjustment to illness
• In hospital environment (inpatient setting, cancer centre)
• In a private setting

Question 2

What are the decisions to be made in this case study?

32, married, one child, Wants another Diagnosed early breast cancer

Answer 2

1. Type of primary treatment
   
   • Mastectomy or lumpectomy + radiotherapy - there is not difference in effectiveness
     
     • If mastectomy = Breast reconstruction or not
     • If breast reconstruction = Immediate or delayed
     • Should the reconstruction be an expander implant or implant only
2. Type of adjuvant (”insurance”) treatment
   
   1. Chemotherapy
   2. Hormone therapy - Issues such as infertility
3. Fertility Options
   
   1. Fertility treatment prior to chemotherapy/hormonal therapy
4. Other decisions
   
   1. Complementary therapy: Clinical trial
      - Need to weigh up medical and personal concerns
      
      • Health quantity of life - benefits in terms of survival
      • Quality of life - Ability to keep the family functioning
        - Treatment side effects
      • Ability to have children/sexuality/body image/fatigue/anxiety
        - Weighing up uncertain risks against uncertain side-effects (additional chemotherapy/hormone therapy - e.g. 20% risk of cancer coming back vs 50% chance of menopausal symptoms

Question 3

What are the different ways of making a decision?

Answer 3

Paternalistic/clinician led approach

• Clinician is the expert
• Takes away burden of decision making
• Projects confidence and care
• Clinician makes the decision in patient’s best interests

Autonomous/Patient-Led

• Clinician tells patient all relevant medical info
• Answers patients questions
• Does not make a recommendation
• Patient decides what decision/treatment to implement

Shared Decision Making (SDM)

• Collaborative process between clinician and patient to make informed, value-sensitive decisions that both agree

Patients & clinicians have different but equally valuable perspectives and roles within the medical encounter

Question 4

How is SDM is effective?

Answer 4

• Increased overall satisfaction with care
• Satisfaction with doctor-patient relationship
• Satisfaction with the decision-making process
• Knowledge
• Quality of life
• Treatment adherence
• Decreased over treatment

Question 5

When should SDM be used?

Answer 5

• One size does not fit all - Patient preferences vary
• Particularly appropriate in preference-sensitive scenarios
  
  • Treatment outcomes are uncertain
  • Quality of life may be affected
  • Patient values determine the best outcome
• HOWEVER, poor SDM implementation in clinical practice

Question 6

How do we implement SDM in clinical practice?

Answer 6

• 3-talk model (Elwyn et al.) - Focused on practical implication of SDM
• What matters for the patient will drive the decision

Question 7

What are the clinician barriers in SDM?

Answer 7

• Not an easy task for the health professional
• Most not trained in SDM - limited opportunities
• Common misconceptions
  
  • Patients will feel unsupported when making decisions
  • It will lead to much longer consultations
  • It will make patients more anxious
  • I already do this
  • Not everybody can do this
  • SDM is too complex for some vulnerable patients, they won’t understand
  • No evidence behind SDM

Question 8

What are the patient barriers in SDM?

Answer 8

• Often feeling emotionally vulnerable and powerless
• Lack a medical vocab
• Conforming to social expectations of patient-doctor roles
• There is great variability in which patients prefer to be involved in medical decision making