Shared Decision-Making


 

Shared decision-making (SDM) has become best practice throughout healthcare as the optimal approach to obtaining informed consent for treatment: SDM should be viewed also as good clinical practice. Five steps to shared decision-making have been described by Epstein et al5:

Step 1: Understand the patient’s experience and expectations

  • Explore what they want from the visit, what they value as outcomes

Step 2: Build partnership

  • Show empathy
  • Outline and discuss the decisions to be made, explain that it will be joint decision-making

Step 3: Provide evidence including uncertainties

  • Explain risks and benefit
  • Present the information with positive and negative framing, and with visual aids
  • Discuss the information in context to the patient

Step 4: Present recommendations

  • Propose a course you think is reasonable

Step 5: Check for understanding and agreement

  • Ask if it makes sense, explore their understanding and reaction, and perhaps the need for more information

 

Shared decision-making – the role of the osteopath and patient

 

Treatment options and their associated risks, benefits, and alternatives should be clearly understood by the patient6. Decisions about treatment should be patient-centred, and patient autonomy must be respected. Patients should be given adequate time to consider treatment options, and any relevant information that exists should be made available to them. Good shared-decision making requires practise so the more you go through the process, the better at it you should become.

 

The patient may have a preferred role in shared decision-making. They may wish

  • to share the decision-making with someone e.g. their osteopath, or a friend/ family member
  • to decide for themselves, perhaps following a discussion with another person

 

Patients should be able to make choices about their treatment without undue pressure from others, and should have confidence in their decision. If it becomes apparent that this is not the case then it is advisable that the clinician delays active treatment.

 

osteo_consultation_male

 

Example conversation

 

 

References

 

5. Epstein RM, Alper BS, Quill TE. Communicating Evidence for Participatory Decision Making. JAMA 2004:291(19);2359-2366

6. O’Connor, A. M., C. L. Bennett, et al. (2009). “Decision aids for people facing health treatment or screening decisions.” Cochrane Database Syst Rev(3): CD001431.

 

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