Transcript Beyond Alcohol: Creating Safe and Supportive Learning

Toward
Shared Decision
Making as the
Norm: What we
All Can Do
Thomas Workman, Ph.D., American Institutes for Research
How Do We Make Decisions?
 We collect information.
 We categorize information into reasons for and reasons
against.
 We weight the list by our likes, dislikes, and values.
 We seek advice and opinions of others.
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How Do We Share Decisions?
Clinicians:
 Provide information about
the benefits and potential
harms of options
 Connect the evidence to
what is known about
patient
 Offer their professional
opinion, recommendation,
and reasoning
Patients and Caregivers:
 Provide information about
health history, goals, and
lifestyle
 Share their thinking about
trade offs based on their
preferences and values
 Offer their personal
opinion, concerns, and
reasoning
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The Goals of Shared Decision Making
 A patient fully understands the potential benefits and
harms of each option.
 A patient applies their personal preferences, life
circumstances, and values when making a choice.
 Both patient and provider reach a mutually satisfying
decision in which both have confidence.
Informed Decision Making Foundation, (2012, February 12). Introduction to Shared Decision Making
& Decision Aids. Available at: http://www.informedmedicaldecisions.org/imdf_provider_tool/an4
introduction-to-shared-decision-making-and-decision-aids/
What are the benefits of SDM?
“Shared decision making has the potential to provide
numerous benefits for patients, clinicians, and the health
care system, including increased patient knowledge, less
anxiety over the care process, improved health
outcomes, reductions in unwarranted variation in care
and costs, and great alignment of care with patients’
values.”
Lee & Emmanuel (2013, NEJM)
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The SDM Process
Invite
Options
Benefits and
Risks
Patient
Preferences
Deliberate
and Decide
Implement
Informed Decision Making Foundation, (2012, February 12). Introduction to Shared Decision Making
& Decision Aids. Available at: http://www.informedmedicaldecisions.org/imdf_provider_tool/an6
introduction-to-shared-decision-making-and-decision-aids/
Applying Patient Preferences and Values
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Length of Life versus Quality of Life
Life Goals and Aspirations
Real Time Goals and Needs
Caregiver Support
Personal Preferences for Treatment Modalities
Fears, Anxieties, and Concerns
Cost Factors
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Making SDM the Norm
PATIENTS/CAREGIVERS CAN:
 Clarify the role they wish to take in decision making
 Provide the clinician with as much information as possible
about their history, interests, values, and preferences
 Ask questions when they do not understand or need more
information
 Communicate openly and honestly when they need more
time or information to think about options
 Clarify their own criteria for decision making
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Making SDM the Norm
CLINICIANS CAN:
 Ensure that the patient/caregiver understands the decision
before them
 Invite the patient and caregiver to actively participate in the
process of decision making
 Provide all possible options and the known benefits and
risks and utilize existing materials to support DM
 Incorporate patient/caregiver values and concerns into the
decision
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Making SDM the Norm
HEALTH CARE ORGANIZATIONS CAN:
 Identify critical conditions and decisions that warrant
shared decision making procedures and build them into the
work flow (use patients/caregivers to help!)
 Ensure there is adequate time and incentives for clinicians
to engage their patients in decision making
 Provide decision support tools that can assist the shared
decision making process
 Employ decision coaches and navigators to assist the
process
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Making SDM the Norm
THE COMMUNITY CAN:
 Engage in conversations about critical health care
decisions and the issues they raise
 Support organizations and clinicians who incorporate
shared decision making into practice
 Encourage community members to actively participate in
the decisions about their health and care
 Educate the community about how to make decisions with
clinicians, how to consider trade offs, and how to ask
questions
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www.pateintfamilyengagement.org
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Decision Aid Resources
 Informed Medical Decisions Foundation.
http://www.informedmedicaldecisions.org/shared-decisionmaking-in-practice/decision-aids/
 Effective Health Care Program, Agency for Healthcare
Research and Quality www.effectivehealthcare.ahrq.gov
 Mayo Clinic http://shareddecisions.mayoclinic.org/
 Ottawa Health Research Institute.
www.ohri.ca/programs/clinical_epidemiology/OHDEC/defa
ult.asp.
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Policy Resources
O’Malley, AS, Carrier, ER, Docteur, E, Shmerling, AC, and
Rich, EU. Policy Options to Encourage Patient-Physician
Shared Decision Making. National Institute for Health Care
Reform Policy Analysis Brief No. 5 (2011, September.
Available at http://www.nihcr.org/Shared-Decision-Making
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