FromTheorytoPracticeHANDS-ONSHAREDDECISIONMAKING

PROV IDED BY THE PREFERENCE LABORATORY

THE DARTMOUTH INST I TUTE FOR HEALTH POL ICY & C L IN ICAL PRACT ICE

ContactUsFormoreinformationonshareddecisionmaking oranyofthe

tools describedinthefollowingmaterials,pleasecontactthe

PreferenceLaboratory attheDartmouthInstituteforHealth

Policy&ClinicalPractice:http://preferencelaboratory.org.

Today’sGoals

Deepenunderstandingofshareddecisionmaking

Getfamiliarwithnewlanguageandperhapsnewideas

Feelconfidentsharingshareddecisionmakingskillswithothers

Finishontimeandhavefun!

SettingtheStageTHEORYOFSHAREDDECISIONMAKING

DefinitionsPreference

Agreatlikingforonealternativeoveranother

EquipoiseAsituationofsufficientbalance

SharedDecisionMaking(SDM)Thepracticeofelicitinganinformedpreferencewhenthereare

treatmentoptionswithclinicalequipoise

ThreeTalkModel

BarriersItisassumedthatSDM:- happensnaturally

- isdonewell

- isinherentinkindpeople

SDMisseenas:- a‘soft’skill

- obvious

SDMtakespracticetodowell

SDMtakespracticetodowellconsistently

MakingtheCase

EthicalImperative

PatientAutonomy

PatientAgency

ToolsandMeasuresIMPLEMENTINGSHAREDDECISIONMAKING

DefinitionsDecisionAids

Rangefromleafletstovideosdesignedtosupportpatientsto

becomeinformedaboutscreening,treatment,andinterventions

EncounterToolsTypesofdecisionaidsdesignedforuseduringavisitatthe

point-of-care toenhancedeliberationofoptions

Clarification

DecisionAids

SharedDecisionMaking

DONOT

EQUAL

AnExample:OptionGridsOptionsGridsareflexibleencountertoolsthatcanhelpengagementinSDMatthepoint-of-care.Formoreinformation:http://optiongrid.org/

UsingOptionGrids

Explainit

Giveit

Useit

…andbeflexible!

MeasuringinPractice

IsSDMactuallyhappening?

HowcanwemeasureifSDMhasoccurredorisimproving?

Whoseperspectiveshouldbemeasured?

Whatarethemostcriticalconsiderationswhenpickingameasure?

TwoExamplesofMeasures

ObserverOPTION5

CollaboRATECollaboRATE isapatient-reportedmeasureofSDMwhereafterahealthvisit,patientsanswerthefollowing3questionsonascaleof0to9.Zero=noeffortwasmade;9=everyeffortwasmade.

1. Howmucheffortwasmadetohelpyouunderstandyourhealthissues?

2. Howmucheffortwasmadetolistentothethingsthatmattermosttoyouaboutyourhealthissues?

3. Howmucheffortwasmadetoincludewhatmattersmosttoyouinchoosingwhattodonext?

Formoreinformation:http://www.collaboratescore.org/

ObserverOPTION5

ObserverOPTION5 isanobserver-reportedmeasureofSDM.Eachofthe5itemsmeasureskeydimensionsofSDMonascaleof0to4.Belowaretheitemsinbrief:

1. Doestheclinicianpresentmultipleoptions?

2. Doestheclinicianestablishapartnershipwiththepatient?

3. Aretheoptionsdescribed?

4. Doestheclinicianaskthepatientfortheirpreferences?

5. Arethepatients’preferencesincludedinthedecisionaboutnextsteps?

Formoreinformation:http://www.optioninstrument.org/

Questions&CommentsLET’SHEARFROMYOU

Editors:Evidence document: http://optiongrid.org/admin/resources/grid/evidences/60.pdf?x=ym0brq8IhPublication date: 2015-05-27 Expiry date: 2016-04-08 ISBN: 978-0-9571887-6-1 License: CC BY-NC-ND 4.0 (International)Download the most current version from: http://optiongrid.org/option-grids/grid-landing/60This Option Grid does not constitute medical advice, diagnosis, or treatment. See Terms of Use and Privacy Policy at www.optiongrid.org.

Knee osteoarthritis: treatment options

Use this Option Grid™ decision aid to help you and your health care professional decide how to best to manage your knee pain andactivity level. The first steps are to become as fit as possible, work to approach your ideal weight, and consider having physicaltherapy. Surgery is normally recommended only after non-operative treatments have been tried.

Frequently AskedQuestions

↓Pain relievers Joint injections (steroids) Knee replacement surgery

Will this reducethe pain I have inmy knee?

It depends on which pain relieversare taken and for how long.Medications like ibuprofen areeffective for 50 in every 100 people(50%). Other over the countermedications, like Tylenol(acetaminophen), including thosethat have codeine, are alsoeffective.

It depends on the medicineinjected. Some people getgood symptomatic reliefafter an injection, which mayinclude pain relief and/orreduced swelling.

About 90 in every 100 people (90%)who have this operation say it leadsto relief of most or all of their pain,over time. 10 in every 100 people(10%) say it does not lead tosignificant pain relief.

Will thistreatment helpimprove myability to beactive?

It may. As you get pain relief, youshould be able to be more activeand this in turn can also help toreduce pain. It may help to take painrelievers before being physicallyactive.

Yes, usually for up to amonth or so after eachinjection. Plan to be moreactive as a result of the painrelief. Advice from a physicaltherapist may help.

Yes, the majority of patientsexperience improvement in theiractivity level. However, noteveryone sees differences in theirability to walk or climb stairs.

Are there anyrisks to thistreatment?

As with all medications, painrelievers have some side effects. Forexample, codeine may lead toconstipation and prolonged use oftablets like ibuprofen (and otherNSAIDs) increases your risk ofstomach bleeding.

There is a small risk offrequent injections causingcartilage damage, especiallyin weight-bearing joints.Allergic reactions andinfections due to jointinjections are uncommon.You might feel slight pain atthe injection site for a fewdays.

Wound infection needing treatmentoccurs in 5 in every 100 people(5%). Joint infection occurs in fewerthan 1 in every 100 people (1%).Blood clots in the leg occur in 2 inevery 100 people (2%). The risks ofsurgery increase if you have otherconditions, such as heart or lungdisease, are a smoker, or areoverweight.

How long will ittake me to feelbetter after thetreatment?

You may start experiencing painrelief within a few days of when youstart taking the medication.

Most people who experiencerelief feel better within thefirst week or so after theinjection.

Pain relief is gradual. You will stay inthe hospital for around three to fivedays. Most people walk unaidedafter 3 months. Full recovery usuallytakes between 6 and 12 months.

Will I need tohave moretreatment orsurgery?

If things don't get better, talk toyour clinician about other treatmentoptions.

Pain relief lasts for up to amonth or so. You can haveup to 3 or 4 injections peryear.

Most knee replacements can last 15years, many last longer.

What are theoutcomes forpeople witharthritis whohave thistreatment?

Many people cope well by usingmedication, being active, and losingweight. Reducing your pain mayhelp you achieve the benefits ofexercise.

Some people have goodrelief by having injectionswhen swelling and paincause problems.

Surgery is usually considered afterother options have been tried.About 80 to 85 in every 100 people(80%-85%) are satisfied afterhaving a knee replacement. About15 to 20 in every 100 (15%-20%)are not satisfied.

*Under Revision: April 2016

Thinking about the appointment you have just had ... 1. How much effort was made to help you understand your health issues?

0 1 2 3 4 5 6 7 8 9 No

effort was

made

Every effort was

made 2. How much effort was made to listen to the things that matter most to you about your health issues?

0 1 2 3 4 5 6 7 8 9 No

effort was

made

Every effort was

made 3. How much effort was made to include what matters most to you in choosing what to do next?

0 1 2 3 4 5 6 7 8 9 No

effort was

made

Every effort was

made

 This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.  

Observer OPTION 5 Measure Score

Item 1: For the health issue being discussed, the clinician draws attention to or confirms that alternate treatment or management options exist or that the need for a decision exists. If the patient rather than the clinician draws attention to the availability of options, the clinician responds by agreeing that the options need deliberation. 0 = No effort 1 = Minimal effort 2 = Moderate effort 3 = Skilled effort 4 = Exemplary effort

Item 2: The clinician reassures the patient, or re-affirms, that the clinician will support the patient to become informed or deliberate about the options. If the patient states that they have sought or obtained information prior to the encounter, the clinician supports such a deliberation process. 0 = No effort 1 = Minimal effort 2 = Moderate effort 3 = Skilled effort 4 = Exemplary effort

Item 3: The clinician gives information, or checks understanding, about the options that are considered reasonable (this can include taking ‘no action’), to support the patient in comparing alternatives. If the patient requests clarification, the clinician supports the process. 0 = No effort 1 = Minimal effort 2 = Moderate effort 3 = Skilled effort 4 = Exemplary effort

Item 4: The clinician makes an effort to elicit the patient's preferences in response to the options that have been described. If the patient declares their preference(s), the clinician is supportive. 0 = No effort 1 = Minimal effort 2 = Moderate effort 3 = Skilled effort 4 = Exemplary effort

Item 5: The clinician makes an effort to integrate the patient’s elicited preferences as decisions are made. If the patient indicates how best to integrate their preferences as decisions are made, the clinician makes an effort to do so. 0 = No effort 1 = Minimal effort 2 = Moderate effort 3 = Skilled effort 4 = Exemplary effort

Total Score 0-20 Rescale 0-100

Scoring Guide

Score Description

0 = No effort Zero effort observed.

1 = Minimal effort Effort to communicate could be implied or interpreted.

2 = Moderate effort Basic phrases or sentences used.

3 = Skilled effort Substantive phrases or sentences used.

4 = Exemplary effort Clear, accurate communication methods used.

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