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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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Our experiences as patients: did you ever feel powerless?

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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

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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?”

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Empowerment allows our relationships to grow in strength