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 and their values and priorities.
When people have good information about the risks and benefits of various treatment options and have 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, UK, 2011)
Things health providers can do
Be clear that the decision is theirs 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, such as the following:
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 this video for more information.
Become competent at using the 3-step model Ask-Build-Check.
Ask-Build-Check is a New Zealand-developed 3-step model that can be used to build health literacy. Read more here.
Ask good questions.
Develop your own set of questions that you feel comfortable using in different situations. Ideas for questions you can use in different SMS situations can be found in this resource. Read more here.
Help them understand the evidence.
Understanding the evidence behind a treatment choice can help people when they're making healthcare decisions. Read more here.
Make sure they have enough of the right information.
Providing people with information about their condition, treatment and self-care options is a crucial element of delivering self-management support. The range of information needs varies widely from person to person, as does the range of skills and strategies required to communicate that information. Read more here.
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 health professionals and the people they are working with on 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, which include everything from 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.
Shared decision making Health Navigator NZ
Making shared decision-making a reality: no decision about me, without me Kings Fund, UK, 2012
Shared decision-making NICE Guidelines Group, UK
Shared decision making Agency for Healthcare Research & Quality, US