Transcript Presentation 3

Shared Decision Making
&Patient Empowerment
in Family Medicine
Introduction to Primary Care:
a course of the Center of Post Graduate Studies in FM
PO Box 27121 – Riyadh 11417
Tel: 4912326 – Fax: 4970847
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Objectives
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Discuss the definition of patient empowerment
Discuss the status of patient empowerment in FP
Explain the need for patient empowerment
Discuss the reasons of powerless patients
Explain how to empower patients
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Contents
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Shared decision making
Patient Empowerment
The old model vs. the new
Common problems that can lead to poor
decisions
• Model for Clinical Problem Solving & ISDM
• What is a "good" health care decision?
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What is Patient Empowerment?
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Patient Empowerment
• Empowerment is a concept that has recently
emerged in the health scene. It embraces the idea
that everyone has the right to make their own
choices about their health care
• because patients are the ones who experience the
consequences of both having and treating their
illnesses, they have the right to be the primary
decision makers regarding their medical
conditions
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Patient Empowerment
• A key part of empowerment is that the patient,
personally, must actively search out sufficient
information to fully understand their health
conditions and their treatment plans
• Although their physician should be involved in
the decision-making process, the final
determination of what is best for the patient is
both the right and responsibility of the individual
patient.
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Why Patient Empowerment?
Remember the “patient centered clinical method”
• Evaluating both the disease and the illness experience
• Understanding the whole person
• Finding common ground with the patient about the
problem and its management
• Incorporating prevention and health promotion
• Enhancing the doctor-patient relationship
• Being realistic
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Why Patient Empowerment?
• Only 9% of consultations with surgeons and primary care
physicians meet full criteria for informed decision making.
Braddock JAMA 1999
• Distinguishing elements of shared decision making occurred in
0-11% of audio taped patient interviews with general
practitioners.
Elwyn 2001
• “.. Checking of understanding, and the involving of patients in
decision making .. are rarely demonstrated” [in video taped
consultations submitted for MRCGP examination].
Campion BMJ 2002
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What is shared decision making?
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• Two definitions of shared decision making:
• The process of interaction of patients with their
health care providers in making health care
decisions
• Involvement of patients with their providers in
making health care decisions that are informed by
the best available evidence about treatment /
screening / illness management options, potential
benefits, and harms, and that consider patient
preferences.
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What is it?
• an individual being an active member of
his/her disease management team
Laura E. Santurri. Patient Empowerment: Improving the Outcomes of Chronic Diseases Through
Self-Management Education. http://www.case.edu/med/epidbio/mphp439/Patient_Empowerment.htm11
Shared decision making
combines the measurement of
patient preferences with evidencebased practice.
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Why is shared decision making
important?
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• Interventions have different benefits/ risks
that patients value differently
• There is no single right answer for everyone
• Ethical principle of patient autonomy and
legal requirement of informed consent
• Evidence-based practice movement
• Increasing realization that an important piece
of evidence is missing without the patient’s
perspective
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• Patients cannot be forced to follow a
lifestyle dictated by others.
• Preventive medicine requires patient
empowerment for it to be effective.
• Patients as consumers have the right to
make their own choices and the ability to
act on them
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Why is the concentration of power in this
relationship with physician?
• Patient is sick, weak, vulnerable, not feeling fully
oneself…
• Patient may be afraid
• Patient in a state of dependency
• Lack of medical knowledge
• Lack of knowledge on the “system” and how it
works
• Unfamiliar environment
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Why is the concentration of power in
this relationship with physician?
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Education
Professional status/authority
Knowledge
Skills
Expertise
Experience
On familiar territory
GATEKEEPER TO HEALTHCARE SYSTEM
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Why Patient Empowerment?
“People whose lives are affected
by a decision must be a part of
the process of arriving at that
decision.”
–John Naisbitt, Megatrends
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How to empower patients
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Education
supporting self care and self-management
Offering a choice of providers
Sharing treatment decisions
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Benefits of Patient Empowerment
• Learning from our patients
• Taking a proactive role
• Providing a support & information service
to our patients and staff
• Complaint Resolution
• Negotiation & Mediation
• Building trust
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The old model vs. the new
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Patient says:
"I hate this
exercise
plan."
Doctor responds
(Old model)
(New model)
"Then try walking after
dinner every night with
your husband for 10
minutes
"What do you hate
about it? What would
help you do better at
it?"
"I don't think Smoking is the leading
cause of preventable
I can quit
death ..."
smoking."
Why do you think that?
What has happened in the
past when you tried to
quit? What concerns you
most when you think about
trying to quit?
"It's hard at first, but just
I haven't
been able to keep trying. You really
test my blood need to keep track of it."
sugar four
times a day."
"What is preventing
you from doing that?
Do you know what the
numbers mean?"
"
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Some useful hints
• The skilled family physician can spend 10 minute with a patient
and the patient feels it was 20 minutes
• Even the busiest physician can accomplish wonders in a few
minutes by indicating that their full attention is on the patient
• Please conclude every interview with the statement “is their
anything else bothering you that we have not discussed?”
• Rather than assuming that the patient have understood the
instructions, ask them to repeat as they understood
• Use the patients name or ask him what he prefer to be called as
• Use “how can I help you? Rather than “what brings you here
today?”
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Presenting concern
“patient’s story”
Model for
Clinical Problem Solving & ISDM
DOCTOR - PATIENT
COMMUNICATION
Hypothesis
Step 1
Establish pt’s role in
decision making
Identify
choices
History and
physical exam
Identified
problem or
diagnosis
Management
/ treatment
Follow-up
Review pt’s preference
for information
Step 4
Present
evidence
Respond to pt’s ideas,
concerns and expectations
re: management
Assess partnership (review previous steps)
Negotiate a decision
Step 7
Agree on an action plan
Step 8
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*ISDM: Informed Shared Decision Making
Step 2
Step 3
Step 5
Step 6
Common problems that can lead to
poor decisions:
• Relationships and roles are unclear
• Objective data are inadequate
• Values, interests and assumptions are
unexplored
• Too few options have been considered
• Alternatives are unclear
• Communication is poor
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What is a "good" health care
decision?
o Well informed, supported by the best
available evidence, weighs pros and cons,
compatible with patient's values and
practical (Dow, 1999).
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Disempowered
Not involved
No dialogue
No Voice in the System
Feeling vulnerable
No Partnership
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Empowerment allows our relationships to grow in strength
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“Coming together is a beginning;
keeping together is progress;
working together is success.”
Henry Ford
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