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What is shared decision making?

What is shared decision making?. Richard Thomson Professor of Epidemiology and Public Health Associate Dean for Patient and Public Engagement Decision Making and Organisation of Care Research Programme Institute of Health and Society Newcastle upon Tyne Medical School.

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What is shared decision making?

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  1. What is shared decision making? Richard Thomson Professor of Epidemiology and Public Health Associate Dean for Patient and Public Engagement Decision Making and Organisation of Care Research Programme Institute of Health and Society Newcastle upon Tyne Medical School

  2. Models of clinical decision making in the consultation SDM is an approach where clinicians and patients make decisions together using the best available evidence. (Elwyn et al. BMJ 2010) Shared Decision Making Informed Choice Paternalistic Patient well informed (Knowledge) Knows what’s important to them (Values elicited) Decision consistent with values

  3. Examples of preference –sensitive decisions • Breast conserving therapy or mastectomy for early breast cancer • Repeat c-section or trial of labour after previous c-section • Watchful waiting or surgery for benign prostatic hypertrophy • Diet and weight loss or medication in diabetes

  4. SDM – why do we do it? • Cochrane Review of Patient Decision Aids(O’Connor et al 2011): • Improve knowledge • More accurate risk perceptions • Feeling better informed and clear about values • More active involvement • Fewer undecided after PDA • More patients achieving decisions that were informed and consistent with their values • Reduced rates of: major elective invasive surgery in favour of conservative options; PSA screening; menopausal hormones • Improves adherence to medication (Joosten, 2008) • Better outcomes in long term care

  5. Are patients involved?

  6. The challenge • Doing it well – barriers and facilitators • We do it already/Not enough time • Access to right information at the right time • Awareness/attitudes • Skills – clinicians – patients • Preference/values elicitation – what is important to the patient • Decision support – e.g. patient decision aids/prompts • Fit to clinical pathways or re-design of pathways • Measurement • Impact at population level – inequalities and link to literacy

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