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From the Classroom to the Clinic:

From the Classroom to the Clinic:. Shared Decision Making. J. Gregory Carroll, PhD. Bayer Institute for Health Care Communication. 555 Long Wharf Drive, 13 th Floor New H aven, CT 06511-5901 800-800-5907 www.bayerinstitute.org. Benefits of Change. Patient Improved health status

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From the Classroom to the Clinic:

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  1. From the Classroom to the Clinic: Shared Decision Making

  2. J. Gregory Carroll, PhD Bayer Institute for Health Care Communication 555 Long Wharf Drive, 13th Floor New Haven, CT 06511-5901 800-800-5907 www.bayerinstitute.org

  3. Benefits of Change Patient Improved health status Clinician Increased satisfaction Health System Reduced costs Family and Friends Greater availability Work Increased productivity

  4. CONCEPTS Stages of change IDENTIFICATION Source: Prochaska & DiClemente

  5. CONCEPTS People don’t adhere • 30 to 40% of all patients fail to follow preventive regimens • 20 to 30% of all patients fail to follow curative medication regimens • 50% of all patients on long term regimens fail to adhere • 50% of all patients requiring life style changes fail to adhere (Hayes et al, 1979; DiMatteo et al, 1994; Clark & Becker, 1998)

  6. CONCEPTS High 10 Convinced Stuck: frustrated Moving: helping Conviction Stuck: unaware or cynical Stuck: skeptical 0 Ambivalent Helpless Powerful Low Confidence High 0 10

  7. CONCEPTS The clinician is the intervention Key elements • Ask before tell: open-ended inquiry; assess conviction and confidence • Build rapport: reflective listening, empathic communication • Tailor the method to match the patient’s conviction and confidence

  8. TECHNIQUES Ask the patient to quantify • “On a scale of 0 to 10, how important is it to you to make this change?” • “On a scale of 0 to 10, how confident do you feel that you can make this change?”

  9. CONCEPTS Enhancing confidence Assist the patient to: • Recall times when she/he has been successful making changes • Make a conscious, deliberate choiceto make the change; support the patient’s autonomy • Move away from an either/or frameof mind

  10. CONCEPTS Enhancing confidence cont. Assist the patient to: • Define steps that are likely to lead to success • Attend to progress and to perceive slips as occasions for problem solving rather than as failure Ask the patient: “For your confidenceto move from a 2 to a 4 on a scale of 10,what would have to happen?”

  11. CONCEPTS Enhancing conviction Assist the patient to: • Illuminate the discrepancies between goals and actions • Discover the normal conflicts of values which lead to ambivalence Provide new information when it is relevant. Ask the patient’s permission

  12. CONCEPTS Enhancing conviction cont. Assist the patient to: • Clarify a values hierarchy • Identify optional reward systems Ask the patient: “For you to become more convinced that this change is in your best interest, say from a 2 to a 4, on a scale of 0 to 10, what would have to happen?”

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