Shared Decision Making Flashcards
True or false- Px’s need to make decisions about their health care
TRUE
True or false- Many Px’s find it difficult to take an active role in decision making about their health care
TRUE
What is the key in engaging Px’s in decision making
effective communication
What are the 3 things Px’s should know about each management option?
- benefits
- risks and harms
- uncertainty
Patient-centred care involves 4 things:
1) treating Px’s with ___
2) responding ____ to px’s needs
3) Providing Px’s with ____
4) Focus on ___ rather than ___
1) treating Px’s with RESPECT and DIGNITY
2) responding QUICKLY to Px’s needs
3) Providing px’s with enough INFORMATION to make informed decisions
4) Focus on PATIENT rather than CONDITION
Where on the scale of paternalistic and informed Px does Patient-centred care sit?
between
- paternalistic –> Dr makes choice
- informed Px –> Px makes choice
What is the most difficult step in EBP?
incorporating Px values, preferences and circumstances
What helps Px’s make informed decision
communicating evidence with Px
True or false- shared decision making is not critical in EBP
FALSE
TRUE OR FALSE- Shared decision making is ethically important
TRUE
What tool can be used to help Px’s with shared decision making?
Decision Aids
What are Decision Aids?
- tool that helps px’s with shared decision making
- informs Px’s
- info on benefits/harms/values
True or false- Decision Aids can help Px’s make decisions better aligned with their values
TRUE
What does shared decision making reduce?
- over-diagnosis
- over-treatment
- inappropriate use of tests/treatments
True or false- shared decision making is a single step added to a consultation
FALSE- it is a process
True or false- shared decision making is provision of Px education
FALSE- a lot more to it
- bidirectional communication and establishing partnership with Px
True or false- shared decision making is giving a Px a decision aid
FALSE- a lot more to it
- tailored to Px needs and circumstances
What steps are involved in Shared Decision Making?
- explaining problem and need for decision
- inviting Px’s engagement
- explaining options and benefits/harms of each
- exploring Px’s values
- Clarifying understanding and answering px questions
- collaborative discussion
- making or deferring decision
True or false- deferring a decision is a step in shared decision making
TRUE- can make or defer decision
How can you gauge the Px’s expectations about management of condition?
Ask e.g. ‘ what have you heard about or know about …?’
What information should be provided alongside discussing benefits and harms?
probability of each occurring (when known)
What are potential harms of a treatment option that are personal to Px?
cost
inconvenience
interference with daily roles
reduced quality of life
What is a method that can be used to ensure Px has understood you?
teach-back method
True or false- duration of consult will be lengthened because of shared decision making?
FALSE - happens throughout consult too
True or false- Px’s will be unsupported when making healthcare decisions?
FALSE- Px’s not forced to make decision by themselves
True or false- not every Px wants to share decision making process with clinician
FALSE- evidence shows otherwise
True or false- not every Px can participate in shared decision making
FALSE
- decrease inequity so engage vulnerable people
Does engaging Px’s with shared decision making increase their anxiety?
NO
- decisional conflict is not the same as anxiety
True or false- shared decision making is the same as informed consent?
FALSE
Should what clinicians inform px’s about in terms of benefits, harms and options be determine by what a ‘reasonable Px’ deems important or by what a ‘group of clinicians’ deems important?
What a reasonable Px deems as important is more important in shared decision making than what clinicians think
Can we assess the quality of decision aids?
YES- using IPDAS (international patient decision aid standards)
What is the best way to communicate the following statistic –> “there is a 20% risk of a side effect”
WHAT NOT TO DO: “there is a 20% chance that you will have side effect with intervention”
- px can interpret as they will have side effect 20% of time
WHAT TO DO: “of every 100 Px’s having this intervention, 20 experience the side effect”
What is the best way to communicate the following statistic –> “By having a screening test, your risk of dying from the disease is reduced by 50%”
- large number can be misleading so Px thinks reduction in death is large
- INSTEAD SAY: ““Your baseline risk of dying from the disease is 1 out of 1000. By undergoing the screening test, this is reduced by half, or to 1 out of 2000”
Define probability:
Chance of event occurring b/w 0 and 1
can be %
Types of probability:
- single probability
- conditional probability
What is single probability
20% chance you will have side effect
What is conditional probability
probability of event given that another event has occurred
- e.g. if Px has disease, probability +ve screening test for disease is 90%
Define odds ratio
odds or something being true in one group compared to another group
Let’s say we find 10 myopes in a sample of 45 people
- The odds of any one individual being a myope is:
- The probability (or risk) of an individual being a myope is:
- ODDS –> 10:35 (or 10 to 35 or 0.29 to 1)
(denominator is remainder) - PROBABILITY –> 10/45 (or 0.22)
(denominator is total)
Are odds and risks the same?
NO- but often similar (esp. in rare case)
How to calculate: Control Event Rare (CER)
probability of developing outcome for control group
CER=c/c+d
Outcome YES Outcome NO
Treatment A b
Control c d
Experimental Event Rate (EER)
probability of developing outcome for experimental group
EER = a / (a+b)
Outcome YES Outcome NO
Treatment A b
Control c d
Relative Risk (RR):
ratio of (probability of developing outcome in treatment groups) / (probability of developing outcome in control group) RR = EER/CER
Absolute Risk Reduction (ARR):
ARR = CER-EER
difference in rates of adverse events b/w control and experimental groups
Relative Risk Reduction (RRR):
RRR = (CER-EER)/CER
extent to which treatment reduces risk compared to no treatment
Number needed to treat (NNT):
NNT = 1/ARR
= 1 / (CER-EER)
i. e. no of px’s needed to treat to prevent one adverse outcome
- ideally want 1 (every treated Px prevents adverse effect)
- usually >1
Should we communicate probabilities to Px?
no- communicate natural frequencies
What should we avoid communicating statistically to Px’s?
probabilities and percentages- can be misleading
What statistics should we communicate with Px?
- natural frequencies (e.g. 1 in 20)
- absolute risk reductions > relative risk reductions
Is it better to communicate relative or absolute risk reduction?
absolute risk reduction
- relative can be misleading
How can we avoid Px’s misinterpreting statistics?
communicate baseline
Should we communicate number needed to treat?
NO- difficult to understand
Words or numbers?
numbers (instead of very common, rare etc.)
Should you present info in positive or negative manner?
Both
Main considerations for format of communications with px?
- Px preference
- Px literacy level
- Px cognitive ability / impairments
- resource available
- time
