Terminology such as shared decision-making may seem unfathomable during a pandemic. Our normal approach to healthcare has disappeared. Arranging an appointment for dental cleaning, a mammogram, or visit to orthopedic surgeon about the relentless ache in your knee are no longer taken lightly. As the virus continues to stalk the world, we are evolving a new normal. Healthcare is the “point of the spear” in this evolution.
What will always remain central to healthcare is the clinician-patient relationship. Nurses, doctors, physical therapists and other members of the care team share a commitment to continually improve care. Today, many are working long hours garbed in heavy protective equipment to keep patients alive. Above all, these are the people who want a form of “normal” to return as soon as possible.
In the days ahead, the Shared Decisions blog will add posts on key concepts that are the foundation of good care. The more people recognize and learn to understand their role in healthcare the more likely we are to improve the way care is offered. No longer is passive acceptance in your best interest. In fact, the literature is replete with examples where harm occurred because the patient did not question a decision. In our post on antibiotics there are two examples from the Infectious Disease Society of America of bad outcomes that resulted.
Three Concepts to Understand:
These three concepts have driven efforts for improving outcomes of care for several decades.
This post describes the basics of shared decision-making.
- Evidence-based practice
- Shared decision-making
- Patient engagement
Yet, none are totally integrated into systems of care, be it an office, a clinic, or hospital.
There are many barriers to change in any organization or industry, and healthcare is no exception. Multiple studies and project have been undertaken to bring patients and clinicians into more effective communication processes. Office or clinic visits are time limited. Hospital stays prior to the pandemic also pointed to limited time for nurses to help patients understand the drugs they were taking, the follow up that would be required or how to manage infusion lines or post-operative incisions once they return home.
Many studies have demonstrated that time is one of biggest barriers to effective communication. So, it is no surprise that patients feel rushed and confused.
Evidence-based care depends on shared decision-making with the patient. When effectively operationalized providing the patient with important information in plain language that explains the risk and benefit of the treatment outcomes have improved. PCORI’s website provides an overview of three common problems where shared decision-making is used. Issues such as prostate cancer, sickle cell, and decision about bariatric surgery are examples where patient engagement-through-knowledge is essential for decision-making.
The patient is the one who will benefit, or not, from a treatment. Patient preference is part of the triad where clinician expertise and best evidence combine for informed conversation. The intersection seen here, in the white space is where the decision-making experience occurs.
Decision aids are key part of the exchange. There are many types of decision aids some come on discs to take home for considerations about a surgical procedure, others are designed for use in a clinic or office setting. The basis of all aids is to make it easier to understand options and to see risk and benefit of a treatment. The Mayo Clinic national resource center for shared decisions offers examples of how decision aids are used.
The trend now shows that more patients ARE active participants when faced with a decision about their health. Sometimes they appear with information they have printed from the internet. The quest to learn is great. However, be sure you are using valid sites such as Medline Plus and other credible sites. There are a number of good resources from the group that really understands how to find best evidence, the Medical Library Association. Their Patients link is very helpful.
Prepare for an office or clinic visit by:
- Dedicate a notebook for healthcare notes
- Prior to your visit, list your key questions
- During the visit ask the clinician to explain terms, even write them down
- Be clear about the amount of time you need to consider options
- Ask for printed or electronic information you can further consider at home
- Bring an advocate when possible
This is the 21st century patient’s approach. Our goal is to provide resources and encouragement with this blog so you can become even more involved with you healthcare.