People living with long-term conditions make decisions and choices every day that affect their health.
So how can you, as a health professional, support people to make good choices that align with their values and preferences?
People make choices and decisions every day. Some of these decisions are life-changing, such as getting married, having children or moving to another place to live. Some choices can be small such as when to go for a walk or what to eat for dinner. The choices people make are generally guided by what they want to do, their knowledge about the pros and cons of a decision as well as their values and priorities.
When people have good information about the risks and benefits of various treatment options and had someone to talk with about these options, they are more likely to make choices that will work for them.
A formal definition of shared decision-making is: "a process in which clinicians and patients work together to select tests, treatments, management or support packages, based on clinical evidence and the patient’s informed preferences. It involves the provision of evidence-based information about options, outcomes and uncertainties, together with decision support counselling and a system for recording and implementing patients’ informed preferences." (Making shared decision-making a reality, The King's Fund publication, July 2011)
Some things health professionals & staff can do
Have you been clear that it is their choice and not yours to make?
People are more likely to follow through on a decision if they have made it themselves rather than being told what to do. Encourage people to ask questions.
What are my options?
What are the benefits and risks?
What is the likelihood of these things happening?
What is the right decision for me?
Watch the video for more information.
Become competent at using the 3 step model Ask-Build-Check. Read more here.
Ask good questions. Read more here.
Helping understand the evidence
Understanding the evidence behind a treatment choice can help people when they're making healthcare decisions. Read more here.
Does the person have enough of the right information? Read more here.
Shared decision making Health Navigator NZ
Making shared decision-making a reality: no decision about me, without me (Coulter and Collins) Kings Fund, 2012
Shared decision-making NICE Guidelines Group
Shared decision making Agency for Healthcare Research & Quality
Has the person been given enough time to consider their options?
Health professionals are often time-constrained and sometimes decisions are made without the patient having had the opportunity to think through whether it is the right choice for them. Giving people permission to take time to review information, talk through options with those close to them and come back to discuss with you at a later stage, often leads to a better outcome for both of you.
Use a decision aid
Decision aids are tools designed to facilitate a conversation between clinician and patient about making a decision about future treatment options and plans of care. Some of these are very simple and others are necessarily more complex. There are large numbers and styles of decision aids everything from a simple paper based tools to larger web based ones. Read more here.
Are the right people in the room?
Who else needs to be there. Is an interpreter, support person or a someone with subject matter expertise needed? People are less likely to follow through on changes if they are unsupported. Enabling wider social support can be a significant enabling factor. Read more here.