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From the Classroom to the Clinic:. Shared Decision Making. J. Gregory Carroll, PhD. Bayer Institute for Health Care Communication. 555 Long Wharf Drive, 13 th Floor New H aven, CT 06511-5901 800-800-5907 www.bayerinstitute.org. Benefits of Change. Patient Improved health status - PowerPoint PPT Presentation
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From the Classroom to the Clinic:
From the Classroom to the Clinic:
Shared Decision MakingShared Decision Making
1904 1-40
J. Gregory Carroll, PhDJ. Gregory Carroll, PhD
555 Long Wharf Drive, 13th Floor New Haven, CT 06511-5901
800-800-5907
www.bayerinstitute.org
Bayer Institute for Health
Care Communication
1904 1-40
Benefits of Change Benefits of Change
Patient Improved health status
Clinician Increased satisfaction
Health System Reduced costs
Family and Friends Greater availability
Work Increased productivity
Patient Improved health status
Clinician Increased satisfaction
Health System Reduced costs
Family and Friends Greater availability
Work Increased productivity
1904 1-40 Source: Prochaska & DiClementeSource: Prochaska & DiClemente
IDENTIFICATIONStages of changeStages of change
CONCEPTSCONCEPTS
1904 1-40
People don’t adherePeople don’t adhere
30 to 40% of all patients fail to follow preventive regimens
20 to 30% of all patients fail to follow curative medication regimens
50% of all patients on long term regimens fail to adhere
50% of all patients requiring life style changes fail to adhere
30 to 40% of all patients fail to follow preventive regimens
20 to 30% of all patients fail to follow curative medication regimens
50% of all patients on long term regimens fail to adhere
50% of all patients requiring life style changes fail to adhere
(Hayes et al, 1979; DiMatteo et al, 1994; Clark & Becker, 1998)
CONCEPTSCONCEPTS
1904 1-40
00 1010
ConvictionConviction
ConfidenceConfidence
1010
00
Stuck: frustratedStuck: frustrated
Stuck: skepticalStuck: skepticalStuck: unaware or cynical
Stuck: unaware or cynical
Moving: helpingMoving: helping
HighHigh
HighHigh
ConvincedConvinced
AmbivalentAmbivalentHelplessHelpless PowerfulPowerful
LowLow
CONCEPTSCONCEPTS
1904 1-40
The clinician is the intervention The clinician is the intervention
Key elements
– Ask before tell: open-ended inquiry; assess conviction and confidence
– Build rapport: reflective listening, empathic communication
– Tailor the method to match the patient’s conviction and confidence
Key elements
– Ask before tell: open-ended inquiry; assess conviction and confidence
– Build rapport: reflective listening, empathic communication
– Tailor the method to match the patient’s conviction and confidence
CONCEPTSCONCEPTS
1904 1-40
Ask the patient to quantifyAsk the patient to quantify
“On a scale of 0 to 10, how important is it to you to make this change?”
“On a scale of 0 to 10, how confident do you feel that you can make this change?”
“On a scale of 0 to 10, how important is it to you to make this change?”
“On a scale of 0 to 10, how confident do you feel that you can make this change?”
TECHNIQUESTECHNIQUES
1904 1-40
Enhancing confidenceEnhancing confidence
Assist the patient to:
Recall times when she/he has been successful making changes
Make a conscious, deliberate choiceto make the change; support the patient’s autonomy
Move away from an either/or frameof mind
Assist the patient to:
Recall times when she/he has been successful making changes
Make a conscious, deliberate choiceto make the change; support the patient’s autonomy
Move away from an either/or frameof mind
CONCEPTSCONCEPTS
1904 1-40
Enhancing confidence cont.Enhancing confidence cont.
Assist the patient to:
Define steps that are likely to lead to success
Attend to progress and to perceive slips as occasions for problem solving rather than as failure
Ask the patient: “For your confidenceto move from a 2 to a 4 on a scale of 10,what would have to happen?”
Assist the patient to:
Define steps that are likely to lead to success
Attend to progress and to perceive slips as occasions for problem solving rather than as failure
Ask the patient: “For your confidenceto move from a 2 to a 4 on a scale of 10,what would have to happen?”
CONCEPTSCONCEPTS
1904 1-40
Enhancing convictionEnhancing conviction
Assist the patient to:
Illuminate the discrepancies between goals and actions
Discover the normal conflicts of values which lead to ambivalence
Assist the patient to:
Illuminate the discrepancies between goals and actions
Discover the normal conflicts of values which lead to ambivalence
Provide new information when it is relevant. Ask the patient’s permissionProvide new information when it is relevant. Ask the patient’s permission
CONCEPTSCONCEPTS
1904 1-40
Enhancing conviction cont.Enhancing conviction cont.
Assist the patient to:
Clarify a values hierarchy
Identify optional reward systems
Ask the patient: “For you to become more convinced that this change is in your best interest, say from a 2 to a 4, on a scale of 0 to 10, what would have to happen?”
Assist the patient to:
Clarify a values hierarchy
Identify optional reward systems
Ask the patient: “For you to become more convinced that this change is in your best interest, say from a 2 to a 4, on a scale of 0 to 10, what would have to happen?”
CONCEPTSCONCEPTS
