Share in decision making

walking

When you have an acute infection, injury or illness, such as appendicitis, cellulitis, or a broken leg, once you present to your GP or hospital, your outcome is more dependent on the health professionals that treat you rather than what you can do at that stage.

For people living with long term conditions (diabetes, heart disease, depression, arthritis and so on) the opposite is true. What you do day to day is VERY IMPORTANT and has a major impact on your long term wellbeing.

Over 99% of all diabetes decisions are made by you, at home, work or elsewhere, independent of your specialist, GP or nurse.

Therefore it is important you take an active role in key decisions about your ongoing treatment. Otherwise, if health providers advise you to do something (eg. take a tablet every day, walk for 30 minutes, attend a programme at the hospital) and this doesn’t fit with your values, priorities or family circumstances (don’t like taking tablets, can’t leave the house as caring for someone else, or no transport to attend hospital appointment), you are unlikely to follow this advice.

Taking an active role includes:

  • Asking questions when you haven’t understood something
  • If advised to do something you don’t think will work for you, make sure you discuss this with the doctor, nurse or person at the time
  • Find out what things you can do to keep yourself well or speed up your recovery
  • Knowing your early warning signs and having a written action plan of what steps you can take at home or when to get help
  • Having a care plan to help coordinate and communicate your goals, priorities, issues and management for the next 12 months
  • Working in partnership with your healthcare team
  • Taking control of the things you can influence
  • Making healthier choices re exercise levels, what you eat, being smokefree etc


Decision Aids

Decision aids are handouts, audio tapes, videos or online resources which help you understand the advantages and disadvantages of a decision. There is good evidence that they can be helpful as it is very difficult to remember all the key points to discuss with every patient about every important treatment decision.

What are decision aids – Ottawa Hospital Research Institute

Ottawa Personal Decision Guide - Ottawa Hospital Research Institute 1 page, interactive pdf useful for any decision

A- Z Specific Decision Aids – Ottawa Hospital Research Institute Over 200 decision aids have been developed and reviewed as part of a Cochrane Review so well tested. NOTE: Most are American and some references to medications or treatment may be different. Discuss with your doctor.

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References

2009 Update: O’Connor AM, Bennett CL, Stacey D, Barry M, Col NF, Eden KB, Entwistle VA, Fiset V, Holmes-Rovner M, Khangura S, Llewellyn-Thomas H, Rovner D. Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD001431. DOI: 10.1002/14651858.CD001431.

O’Connor A, Bennett C, Stacey D, Barry M, Col N, Eden K, Entwistle V, Fiset V, Holmes-Rovner M, Khangura S, Llewellyn-Thomas H, Rovner D. Do Patient Decision Aids Meet Effectiveness Criteria of the International Patient Decision Aid Standards Collaboration? A Systematic Review and Meta-analysis. Med Decis Making 2007. doi:10.1177/0272989X07307319

Shared Decision Making Presentation – Dartmouth Medical School

Framework for teaching and learning informed shared decision making Angela Towle, and William Godolphin,  British Medical Journal  1999 September 18; 319(7212): 766–771.  http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1116602

Barriers and Facilitators to Shared Decision-making Among African-Americans with Diabetes. Peek ME, Wilson SC, Gorawara-Bhat R, Odoms-Young A, Quinn MT, Chin MH. J Gen Intern Med. 2009 Jul 4. [Epub ahead of print]

A typology of shared decision making, informed consent, and simple consent. Whitney SN, McGuire AL, McCullough LB Ann Intern Med. 2004 Jan 6;140(1):54-9.

Shared decision making and its role in end of life care. Frank RK. Br J Nurs. 2009 May 28;18(10):612-8

Shared decision-making in primary care: the neglected second half of the consultation.
G Elwyn, A Edwards, and P Kinnersley    Br J Gen Pract. 1999 June; 49(443): 477–482.

Evidence Based Medicine and Shared Decision Making: the challenge of getting both evidence and preferences into health care. Barratt A.  Patient Educ Couns. 2008 Dec;73(3):407-12. Epub 2008 Oct 8.

O’Connor AM, Stacey D, Entwistle V, Llewellyn-Thomas H, Rovner D, Holmes-Rovner M, Tait V, Tetroe J, Fiset V, Barry M, Jones J. Decision aids for people facing health treatment or screening decisions (Cochrane Review). In: The Cochrane Library, 2004; Issue 1. Chichester, UK: John Wiley & Sons, Ltd.