Six Steps of Shared Decision Making

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The shared decision making process broken down into six steps for health care providers to use as a guide in consultations with their patients.

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Six Steps of Shared Decision Making

  1. 1. F o r H e a l t h C a r e P r o v i d e r s Six Steps of Shared Decision Making (SDM) Richard Wexler, MD Chief Medical Officer February 2012
  2. 2. Introduction • Shared decision making is a collaborative process that allows patients and their providers to make health care treatment decisions together, taking into account the best scientific evidence available, as well as the patient’s values and preferences.This process gives patients the support they need to make the best care decisions for their own needs, while allowing providers to feel confident in the care they prescribe. © 2012 Healthwise, Incorporated. All Rights Reserved. 2
  3. 3. The Six Steps to SDM • These Six Steps of Shared Decision Making and sample language can help providers work with patients to make better decisions together. 3© 2012 Healthwise, Incorporated. All Rights Reserved.
  4. 4. 1. Invite the patient to participate • Often patients don’t realize that there is more than one viable option for treatment. By offering an invitation, you are letting them know that they have choices and that their goals and concerns are an important part of the decision-making process. 4© 2012 Healthwise, Incorporated. All Rights Reserved.
  5. 5. 1. Invite the patient to participate Sample language: • “There’s a decision to make about your treatment (or testing), and I’d like to make it with you. Knowing what’s important to you will help us make a better decision.” OR • “Sometimes things in medicine aren’t as clear as most people think. Let’s work together so we can come up with the decision that’s right for you.” 5© 2012 Healthwise, Incorporated. All Rights Reserved.
  6. 6. 2. Present the options • Before making an informed decision, patients need to know all the options available to them. 6© 2012 Healthwise, Incorporated. All Rights Reserved.
  7. 7. 2. Present the options Sample language: When NOT using a decision aid: “Here are some choices we can consider.” OR “Here are your options.” 7© 2012 Healthwise, Incorporated. All Rights Reserved.
  8. 8. 2. Present the options Sample language: When using a decision aid: “Did you have a chance to read or watch the material about your options?Which of the treatments (or tests) would you like to discuss? OR “Let’s take a few minutes to review the options you have.” 8© 2012 Healthwise, Incorporated. All Rights Reserved.
  9. 9. 3. Provide information on benefits and risks • Give balanced information. Use numbers rather than words when you can.Without them, patients tend to overestimate the benefits and underestimate the risk, and their expectations are less realistic. It’s also important to check in with patients to make sure that they correctly understand the potential benefits and harms. 9© 2012 Healthwise, Incorporated. All Rights Reserved.
  10. 10. 3. Provide information on benefits and risks Sample language: “Let’s go over the benefits and the risks of the options you’re considering.” To check for understanding: “You’ve seen a lot of numbers which can be confusing. Do you have any questions? May I help you sort through them?” OR “I want to be sure that I’ve explained things well. Please tell me what you heard (or wrote down) about __________ (most important benefits and risks).” 10© 2012 Healthwise, Incorporated. All Rights Reserved.
  11. 11. 4. Help the patient evaluate the options based on their goals and concerns • Patients may not be comfortable raising their personal goals and concerns for treatment. By actively inquiring, you are giving them permission to speak about what is important to them. Once you have elicited this information, you can help them look at their options based on their preferences. 11© 2012 Healthwise, Incorporated. All Rights Reserved.
  12. 12. 4. Help the patient evaluate the options based on their goals and concerns Sample language: “Just as people are different, no one decision is right for everyone. As you think about your options, what’s important to you?” OR “People have different goals and concerns. As you think about your options, what’s important to you? For example, some people…while other people…” 12© 2012 Healthwise, Incorporated. All Rights Reserved.
  13. 13. 5. Facilitate deliberation and decision-making • Patients may not be ready to make a decision immediately. Probing for what else they need to know or do before they make the decision can be helpful. If they are ready to decide, you can help facilitate a final decision. 13© 2012 Healthwise, Incorporated. All Rights Reserved.
  14. 14. 5. Facilitate deliberation and decision-making Sample language: “Considering what we’ve discussed, do you have a preference about the direction we take?” “You have time to think things over.” “Do you want to think about this decision with anyone else, someone who might be affected by the decision, someone who might help you sort things out?” “Is there any more information you need?” “What’s the hardest part about deciding?” “From what I hear you saying, here’s what I’d suggest…how does that sound to you?” 14© 2012 Healthwise, Incorporated. All Rights Reserved.
  15. 15. 6. Assist with implementation • Close the conversation by laying out the next steps for the patient. 15© 2012 Healthwise, Incorporated. All Rights Reserved.
  16. 16. 6. Assist with implementation Sample language: “Let’s take a moment to talk about the next steps.” 16© 2012 Healthwise, Incorporated. All Rights Reserved.

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