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Shared Decision Making Shared Decision Making in Family Medicinein Family Medicine
Introduction to Primary Care: a course of the Center of Post Graduate Studies in FM
PO Box 27121 – Riyadh 11417Tel: 4912326 – Fax: 4970847
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Objectives
• At the end of this session the participants will be able to;– discuss the definition of patient empowerment– discuss the status of patient empowerment in FP– explain the need for patient empowerment– explain the power/relationship graph– discuss the reasons of powerless patients– explain how to empower patients
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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.htm
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The idea behind
• 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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• 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
Why Patient Empowerment?Remember the “patient centered clinical method”
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• 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
Why Patient Empowerment?
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“People whose lives are affected by a decision must be a part of the process of arriving at that decision.”
–John Naisbitt, Megatrends
Why Patient Empowerment?
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Power
Relationship
PartnershipTransaction
Keep
Share
The Power/Relationship Graph
http://ejc.sagepub.com/cgi/reprint/19/3/417.pdf?ck=nck
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Impose Dictate
Compromise Common ground
Problem Solving
Power
Relationship
PartnershipTransaction
Keep
Share
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USA Japan
China
Sweden
UK
Italy
Middle east
France
Russia
Germany
Countries
Power
Relationship
PartnershipTransaction
Keep
Share
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• Education• Professional status/authority• Knowledge• Skills• Expertise• Experience• On familiar territory• GATEKEEPER TO HEALTHCARE SYSTEM
Why is the concentration of power in this relationship with physician?
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• 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
Why is the concentration of power in this relationship with physician?
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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
/ 1815Follow-up
Management / treatment
Presenting concern“patient’s story”
History and physical exam
Hypothesis
Identified problem or diagnosis
Identify choices
Review pt’s preference for information
Present evidence
Respond to pt’s ideas, concerns and expectations
re: management
Assess partnership (review previous steps)
DOCTOR - PATIENT COMMUNICATION
Establish pt’s role in decision making
Agree on an action plan
Negotiate a decision
Model forModel forClinical Problem Solving & ISDMClinical Problem Solving & ISDM
Step 1 Step 2
Step 3
Step 4
Step 5
Step 6
Step 7
Step 8
**ISDMISDM: Informed Shared Decision Making: Informed Shared Decision Making
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Feeling vulnerable
Not involved No dialogue
Disempowered
No Partnership
No Voice in the System
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Some useful hints before finishing
• 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?”