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Health Literacy

Shared decision making and decision aids

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Learning outcomes

You are able to:

select, describe and demonstrate effective communication techniques to involve clients (their relatives or significant others) in shared decision-making.

encourage clients to ask questions
educate clients to participate in shared decision-making
involve clients in shared decision-making

Know the function of decision aids

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Shared Decision Making

Therapist and client make health-related decisions collaboratively

After having discussed:� the options and� the likely benefits, and harms of each option�

And considering the patient’s:� values, preferences and circumstances.

[Hofmann et al., 2022]

Image 1: Shared decision making

Shared decision making – definition as mentioned on the slide: Therapist and client make health-related decisions collaboratively after having discussed: the options and the likely benefits, and harms of each option and considering the patient’s: values, preferences and circumstances.

�Shared decision making is integral to high-quality, evidence-based, and patient-centred physiotherapy practice. It involves therapists and patients collaboratively making a health-related decision after having discussed the options, the likely benefits and harms of each option, and considered the patient's values, preferences and circumstances. SDM is a crucial part of the final step in evidence-based practice, the skills to facilitate shared decision-making are important for physiotherapists.�Hoffmann, T., Bakhit, M., & Michaleff, Z. (2022). Shared decision making and physical therapy: What, when, how, and why?. Brazilian Journal of Physical Therapy, 100382.�

Example 3 questions

1. What are my options?

2. What are the benefits and possible risks?

3. How likely are these risks and benefits?

These questions were displayed in a waiting room or circulated with an appointment letter, to encourage patients to take an active part in shared decision making. The programme improved individuals’ health outcomes and experience, with patients reporting that they were more involved, listened to and had greater control of what happened to them. www.health.org.uk/programmes/magic-shared-decision-making (zie : https://www.england.nhs.uk/wp-content/uploads/2016/12/demand-mgnt-good-practice-guid.pdf

https://www.wawn-street-surgery.nhs.uk/information/ask-3-questions/

Achieving shared decision-making depends on building a good relationship with your client. During SDM information is shared and clients are supported to deliberate and express their preferences and views during the decision-making process. To accomplish SDM Elwyn et al. described a model of how to do shared decision-making that is based on choice, option, and decision talk. The model has different steps: a) introducing choice, b) describing options, and c) helping patients explore preferences and make decisions. This model acknowledges that decisions should be influenced by exploring and respecting “what matters most” to patients as individuals and that this exploration depends on them developing informed preferences.

Elwyn, G., Frosch, D., Thomson, R., Joseph-Williams, N., Lloyd, A., Kinnersley, P., ... & Barry, M. (2012). Shared decision making: a model for clinical practice. Journal of general internal medicine, 27(10), 1361-1367.

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Client involvement in shared decision making

1. Introduction phase

2. Offer help

3. Discuss options

4. Find out patient preference

5. Make an action plan/set goals

Teach back

[Elwyn et al., 2013]

Achieving shared decision-making depends on building a good relationship with your client. During SDM information is shared and clients are supported to deliberate and express their preferences and views during the decision-making process. To accomplish SDM Elwyn et al. described a model of how to do shared decision-making that is based on choice, option, and decision talk. The model has different steps: a) introducing choice, b) describing options, and c) helping patients explore preferences and make decisions. This model acknowledges that decisions should be influenced by exploring and respecting “what matters most” to patients as individuals and that this exploration depends on them developing informed preferences.

Observing patient involvement in decision making - Option

Elwyn, G., Tsulukidze, M., Edwards, A., Légaré, F., Newcombe, R. (2013). Using a 'talk' model of shared decision making to propose an observation-based measure: Observer OPTION 5 Item. Patient Education & Counseling, 93 (2): 265-71. doi: 10.1016/j.pec.2013.08.005

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Step 1: introduction phase

Purpose and procedure shared decision making.�Repeat the request for help.�Explain that you will discuss different options together.��

Step 2: offer help

Tell the client you will explain everything as clearly as you can.

Encourage the client to participate and ask questions.

[Elwyn et al., 2017]

Image 2. Shared decision making by Elwyn et al., 2017

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Step 3: Discuss options

Provide information about each intervention (treatment) option: - including the pros and cons of different options� - including no treatment.

Remember the “providing information” skills!

Use teach-back regularly.

[Elwyn et al., 2017]

Image 2. Shared decision making by Elwyn et al., 2017

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Step 4: Find out client preference

Support the client to share their perspective/personal preference.

What does the client think of the benefits/ risks of different treatment options in the short term and in the long term? Also, discuss the client’s motivation for each option.

Decide together.

[Elwyn et al., 2017]

Image 2. Shared decision making by Elwyn et al., 2017

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Step 5: Make an action plan / set the goals

Make an action plan/set goals.

Make sure it is clear what the client can expect from you

and what you expect from the client.

Use teach-back!

[Elwyn et al., 2013]

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Decision Aids – support client preference

Patient decision aids are tools designed to communicate the best available evidence on treatment or screening options to patients

in ways that encourage them to engage with their providers to choose an intervention that is

🡪 consistent with the evidence AND

🡪 with their personal values.

Decision aids can support the decision talk during the steps of shared decision making.

[Holmes-Rovner et al., 2007]

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Decision Aids includes

necessary informations about the health problem as the starting point for a discussion with patients about their preferred option.
structure of a decision tree to describe each option, its outcomes, and related probabilities to facilitate patient judgments of the benefits versus the harms.
patient and professional roles based on their level of exchange of information about options, outcomes, risk management, values, and control over choices.

[Holmes-Rovner et al., 2007]

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Adressing HL in Patient Decision Aids

International Patient Decision Aid Standards (IPDAS) quality criteria checklist includes the use of „Plain language“:

Is written at a level that can be understood by the majority of patients in the target group
Is written at a grade 8 equivalent or less according to readability score (SMOG or FRY)
Provides ways to help patients understand information other than reading (audio, video, in-person discussion)

Professionals need to check if there used materials tailored to all people.

Decision aids can be a support in finding the best treatment.

[Muscat et al., 2021]

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Follow up after the visit

Image 3. Senior male patient meet therapist

Let patients know that you are interested in helping them achieve behavior change. Ideally, set up a time to follow up a week or two after the patient’s visit.

If the goal wasn’t met, help patients develop a plan that can be achieved.

If the goal was achieved, celebration and praise are in order. Work with patients to plan the next step. Each small step gets patients closer to the ultimate goal of improving their health-related behaviors.

It can be tempting to make suggestions, but action plans need to come from the patients.

Try having a menu of options (e.g., lists of exercises, foods to cut down on) that can give patients ideas for specific steps they can take.

Ask patients when they want to start. Having a concrete date sets patients in motion.

Ask patients whose help they can enlist in completing their action plan. Support at home is an important determinant of success.

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Shared decision-making – I involve patients with limited health literacy in shared decision making
27. I confirm the request for help and indicate that I we will discuss the various treatment options together.
28. I reassure the client that I will support and provide clear information, so that the client is enabled to participate in decision-making.
29. I discuss the treatment options and the likely benefits, and harms of each option with the client.
30. I support clients to explore ‘what matters most to them’, considering the client’s: values, preferences and circumstances.
31. I support the client to make an informed decision together (when necessary, after time to absorb and to discuss with significant others)

[Elwyn et al., 2013; Jorna-Lakke et al., n.d.}

Questionnaire/Self-reflection

Steps of option 5�Achieving shared decision-making depends on building a good relationship with your client. During SDM information is shared and clients are supported to deliberate and express their preferences and views during the decision-making process. To accomplish SDM Elwyn et al. described a model of how to do shared decision-making that is based on choice, option, and decision talk. The model has different steps: a) introducing choice, b) describing options, and c) helping patients explore preferences and make decisions. This model acknowledges that decisions should be influenced by exploring and respecting “what matters most” to patients as individuals and that this exploration depends on them developing informed preferences.

�Observing patient involvement in decision making - Option

�1 Elwyn, G., Tsulukidze, M., Edwards, A., Légaré, F., Newcombe, R. (2013). Using a 'talk' model of shared decision making to propose an observation-based measure: Observer OPTION 5 Item. Patient Education & Counseling, 93 (2): 265-71. doi: 10.1016/j.pec.2013.08.005

2. Modified Option5 for Physiotherapists – Shared Decision Making Network (Jorna-Lakke S., Van der Veer R., Offringa T., Tan C., Hanzehogeschool Groningen, n.d.)

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Image 1. Shared decision making designed by Drazen Zigic, free license by freepik

Image 2. Picture of Elwyn, G., Durand, M. A., Song, J., Aarts, J., Barr, P. J., Berger, Z., ... & Van der Weijden, T. (2017). A three-talk model for shared decision making: multistage consultation process. bmj, 359.

Image 3: Senior male patient meet therapist to receive medical consultation designed by fizkes from shutterstock, free license by shutterstock

All icons/pictograms from PowerPoint® for Microsoft 365 MSO (Version 2205 Build 16.0.15225.20172) 64 Bit )

References

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Hoffmann, T., Bakhit, M., & Michaleff, Z. (2022). Shared decision making and physical therapy: What, when, how, and why?. Brazilian Journal of Physical Therapy, 100382.
Elwyn, G., Tsulukidze, M., Edwards, A., Légaré, F., Newcombe, R. (2013). Using a 'talk' model of shared decision making to propose an observation-based measure: Observer OPTION 5 Item. Patient Education & Counseling, 93 (2): 265-71. doi: 10.1016/j.pec.2013.08.005
Elwyn, G., Durand, M. A., Song, J., Aarts, J., Barr, P. J., Berger, Z., ... & Van der Weijden, T. (2017). A three-talk model for shared decision making: multistage consultation process. bmj, 359.
Holmes-Rovner, M., Nelson, W. L., Pignone, M., Elwyn, G., Rovner, D. R., O'Connor, A. M., . . . Correa-de-Araujo, R. (2007). Are patient decision aids the best way to improve clinical decision making? Report of the IPDAS Symposium. Med Decis Making, 27(5), 599-608. doi:10.1177/0272989x07307272
Muscat, D. M., Shepherd, H. L., Nutbeam, D., Trevena, L., & McCaffery, K. J. (2021). Health Literacy and Shared Decision-making: Exploring the Relationship to Enable Meaningful Patient Engagement in Healthcare. J Gen Intern Med, 36(2), 521-524. doi:10.1007/s11606-020-05912-0
Modified Option5 for Physiotherapists – Shared Decision-Making Network (Jorna-Lakke S., Van der Veer R., Offringa T., Tan C., Hanzehogeschool Groningen, n.d.)
Koninklijk Nederlands Genootschap voor Fysiotherapie (KNGF) / Vereniging van Oefentherapeuten Cesar en Mensendieck (VvOCM). KNGF-richtlijn Zelfmanagement. Amersfoort/Utrecht: KNGF/VvoCM; 2022

Literature