Episode #13: The Role of Directive and Shared Decision-making in Person-Centered Care
The Role of Directive and Shared Decision-making in Person-Centered Care
Introduction to Episode:
“Patients are the co-pilot in the airplane called better healthcare” Ben Moulton
This is a very interesting episode because today we’re talking with Glyn Elwyn a physician/researcher and Ben Moulton a lawyer/patient advocate about the Directive and Shared Decision-Making Polarity.
This polarity can show up in different contexts, leaders and employees, parents and children, but today we are discussing this polarity within the context of decision-making between the provider and patient/family.
At the heart of person-centered care is partnering with individuals and their families in planning, developing and monitoring care in a way that best meets their needs and is considerate of their preferences.
To be person-centered individuals need to not only act in a person-centered manner but also think in that way.
Historically the provider was the expert and had the answers and directed the care and patients/families were followers or passive participants.
Today there is a desire to have decision-making be an experience where the expertise of the provider along with the values, beliefs and needs of the patient/family are leveraged.
The challenge is providers and patients and families aren’t always equipped to engage in shared decision-making.
Glyn and Ben share with us what is happening nationally in support of shared decision-making and how decision aides can prepare both providers and patients/families to participate in the shared decision-making process.
During This Episode We Discuss:
· There are times when it is reasonable to be directive
· Medicine is full of situations with multitudes of choices
· Use tools to help ground conversations in fact
· There is a downside to directive decision-making
· True informed consent is shared decision-making
· Physicians are not typically trained in shared decision-making
· Downsides of shared decision-making
· A tool is a catalyst but requires the right attitude, motivation, and skills to use it
· Need culture, buy in, and leadership to advance shared decision-making
Resources:
Spatz, E. S., Krumholz H. M., & Moulton, B. W. (2016). The new era of informed consent: Getting to a reasonable-patient standard through shared decision- making. JAMA, 315(19): 2063–2064. doi:10.1001/jama.2016.3070
King, J. & Moulton, B. (2013). Group Health's participation in a shared decision-making demonstration yielded lessons, such as role of culture. Health Affairs, 32(2): 294-302. doi: 10.1377/hlthaff.2012.1067
Spatz, E. S., Krumholz, H. M., & Moulton, B.W. (2017). Prime time for shared decision-making. JAMA, 317(13): 1309-1310.
King, J. & Moulton, B. (2006). Rethinking informed consent: The case for shared decision- making. American Journal of Law & Medicine, 32: 429-501.
Sirovich, B., Gallagher, P., Wennberg, D., & Fisher, E. (2008). Discretionary decision-making by primary care physicians and the cost of the U.S. health care. Health Affairs, 27(3): 813-822.
Option Grid™ Decision Aids
https://health.ebsco.com/products/option-grid
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