Lecture 2 SDM Flashcards
Shared decision making involves _______ consent and ______ choice plus….
Informed, informed
- identify pattyienty needs, values and preferences
- discuss uncertaintes of treatment, experience of provider, costs
- two way convo with patient/family having role in decision
What is evidence based clinical practice (three fundamental principles)
- Decision making requires awareness of the best available evidence, which ideally comes from systematic evidence reviews
- EBM provides guides to determine strengths of evidence
- Evidence alone is never enough
When to use SDM?
- When patient preference emitter in selecting treatment
- Equipoise: when treatment are equally effective, so patient outcomes are not compromised
When SDM should be considered (care options)
There are at east 2 medically valid options with a balance between benefits and harms
Many weak or conditional recommendations
In specific circumstances even if the balance between benefit and harms is usually not in equiposie
Some strong recommendations in favour of action
When SDM should probably not be considered
There us no decision to be made
Patient cannot collaborate in the process
Balance between benefits and harms is not in equipoise
When not to use SDM?
Wider interests override individual preference
Absence of evidence
Lowered decisional capacity
Profound existential crisis
What is team talk?
Establishing collaboration
Declaring alternatives
Justify choice : emphasis importance of respecting individual preferences, and role of uncertainty
Check reaction
Defer closure
What is option talk?
SUMMARIZE AND CHECK UNDERSTANDING (TEACH BACK)
Checking knowledge
Listing options
Describing options
Exploring harms and benefits
Providing patient decision support
Summarizing
What is decision talk?
Focusing on preferences
Eliciting and integrating preferences
Moving to a decision
Offering review
