Shared Decision-making

by Mark Hughes, MD, MA

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    00:01 Alright, so that brings us to a new model of shared decision making.

    00:07 This is especially important when it's decisions that are value laden, that really it matters more about the patient's value system and their preferences about how they might make the decision.

    00:18 It's also important when what we're proposing.

    00:21 There might be two options that seem relatively equal.

    00:26 They seem to have equal medical benefit in terms of managing that condition.

    00:31 So there needs to be a back and forth exchange of information to really understand the patient's preferences.

    00:37 Use that information to help guide them in making what I would call a shared decision making.

    00:42 It's both the clinician and the patient coming to a decision mutually together.

    00:49 So it starts with information exchange.

    00:51 So things that are personally meaningful information for the patient.

    00:55 We're exploring those, we're trying to understand the patient's experience, what their expectations are.

    01:02 We're trying to provide them the evidence that they need to understand how they can manage their condition, including the possibility there might be uncertainties along the way.

    01:13 And how do they as a person deal with uncertainty.

    01:17 The second phase of shared decision making is going to be deliberation.

    01:20 So there, there's an actual interaction of exchanging of opinions.

    01:25 So you're creating a safe environment for them to freely share their thoughts.

    01:30 You're reacting to what they're saying, hopefully trying to enhance the discussion, so that they can reach a decision that seems best for them.

    01:42 And then lastly, you do reach the decision.

    01:44 So this is a collaboration reaching an agreement on the treatment, where it's going to be the physician being transparent of their assessment of the situation and why they think this treatment might be preferable to the alternative treatment based on the knowledge that they've learned from the patient about their preferences.

    02:06 Which then leads to this issue of transparency.

    02:09 So you're really trying to use your communication skills to give your thought process, you're thinking about the matter, as transparently as possible.

    02:24 So you're sort of giving the reasoning behind the decision that you think is going to be best for the patient.

    02:29 It's only after you've learned from them, you know what's important to them.

    02:33 So you're integrating that information into your reasoning process.

    02:39 And why you would say, "Well, I recommend this one over the alternative." Again, it's still gonna be up to the patient to decide if it's right for them, but you're being transparently open about how you're thinking about the situation.

    02:54 And the hope is that this mutual exchange really gets to the goals and values that are going to be important for the patient in the future.

    03:01 So I really see this as an opportunity to think aloud using language that the patient understands, again, to enhance their ability to make good decisions.

    About the Lecture

    The lecture Shared Decision-making by Mark Hughes, MD, MA is from the course Informed Consent and Capacity.

    Included Quiz Questions

    1. This will allow for a consideration of the goals and values that are important to the patient.
    2. This will allow patients to accept the physician's option as correct.
    3. This will allow for respect-building between the physician and the patient.
    4. This will allow patients to recognize the wisdom of a healthcare professional.
    5. This will allow for patient autonomy.
    1. Information exchange
    2. Reading assignment
    3. Combative disagreement
    4. Reconciliation

    Author of lecture Shared Decision-making

     Mark Hughes, MD, MA

    Mark Hughes, MD, MA

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