IHI Patient safety modules + shared decision making

Question 1

What is a paternalistic clinician like? Example?

Answer 1

Give opinion
“I would like you to start a medication for your bones today”

Question 2

What is an informative clinician like? Example?

Answer 2

Proves information
- Here is a pamphlet that describes your risk of having a fracture over the next 5 years. It outlines a few medications. Take a look and let me know what you’d like to do

Question 3

What is a shared decision making clinician?

Answer 3

Gives opinion and information

Question 4

Why shared decision making?

Answer 4

• Patients have the right to understand their condition and treatment options
• Help patients be more active in the treatment decision process
• Patient’s less likely to take ineffective medication

Question 5

What are the 5 steps of shared-decision making

Answer 5

Step 1: Understand Patients experiences/expectations
- What are you hoping for in this visit
- Would you like to invite your partner into the discussion

Step 2: Develop a relationship
- Ask about employment, family, recreation
- Don’t rapid fire questions.

Step 3 provide evidence
- Define everything (all terminology) (Do not assume they know what a stroke is)
- Estimate risk with no therapy
○ Provide benefits and harms of therapy
○ If evidence is uncertain still tell them!!
- Present evidence in multiple forms (pictures, verbal, written)

Step 4: present recommendations
“We could try a tricyclic antidepressant that may help your pain, even though the evidence is not in as to how well it works.”

Step 5: Assess understanding
- Ask patient to repeat the info
○ “does this make sense?”
- Schedule a follow-up