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Self-Management Support: Shared Decision-Making

Self-Management Support: Shared Decision-Making. Stephen Taplin MD, MPH 3/21/07 Adapted from work by Michael G. Goldstein, MD Bayer Institute for Health Care Communication. Session Overview. Panel Discussion: Examples from the field Lake County Others Group Discussion: Lessons Learned

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Self-Management Support: Shared Decision-Making

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  1. Self-Management Support:Shared Decision-Making Stephen Taplin MD, MPH 3/21/07 Adapted from work by Michael G. Goldstein, MD Bayer Institute for Health Care Communication

  2. Session Overview • Panel Discussion: Examples from the field • Lake County • Others • Group Discussion: Lessons Learned • What’s getting in the way? • Who is responsible for each part? • What has been working? • What are your successes?

  3. What is Self-Management Support? Help people: • understand • decide • choose • change behavior • overcome barriers • follow-through

  4. What is the difference between Self-management and shared-decision making? • See Handout #1 • Both are about “support” • People will decide if they want to be screened • People will decide how they will manage their disease

  5. Self-management • People with chronic conditions must make ongoing adaptations in their daily lives. • Self management encompasses all activities patients perform • to control their illness, • prevent future complications, • and cope with the impact of the disease & its treatment on themselves & others [i] Briss P., Rimer B., Reilley B., et al. (2004). Promoting Informed Decisions About Cancer Screening in Communities and Healthcare Systems. Am J Prev Med 26(1): 67-80

  6. Shared Decision Making • Shared decision making accounts for values and preferences in the treatment decision-making process, and is made up of one-on-one interactions to understand and consider: • the risks, benefits, health outcomes alternatives, and uncertainties of an action • and consider the patients values regarding the potential benefits and harms associated with the preventive service. • Both the patient and the clinician provide information and express their preferences, and the patient engages at a decision-making level at which he or she feels comfortable. . • Sheridan S. (2004). Shared decision making about screening and chemoprevention: A suggested approach from the U.S. Preventive Services Task Force.  Am J Prev Med 26(1): 56-66. • Glasgow R.E., Orleans C.T., Wagner E.H., et al. (2001). Does the chronic care model serve also as a template for improving prevention? Milbank Quarterly 79(4): 579-612, iv-v

  7. SMS needs vary across the spectrum of health care targets Social, Community, Cultural and Environmental Factors Patient Preferences and Values Behavior Information Getting a mammogram Routine exercise

  8. 5As - Brief Counseling • Assess (knowledge, behavior, readiness) • Advise and inform • Agree (on goals and methods) • Assist (overcome barriers) • Arrange follow-up Whitlock et al, 2002 Am J Prev Med 22:267-84

  9. Self-Management Support is an ongoing interactive process • Assessment is key • Respond and Tailor • Activate and Empower • Team Approach • Multiple opportunities • Follow-up on progress

  10. What do we know that works? • The process and environment matter • See handout #2

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