Shared decision making: An unachievable aim or a current reality for consumers? Susan Biggar Health Issues Centre 13 October 2014

When life changes…

Shared decision making is a great idea…like apple pie and baseball to an American …but in reality, does it happen?

The decision fundamentally belongs to the patient; it’s their health In order for shared decision-making to become natural and intrinsic to health care, we must believe in the patient’s fundamental right to decide. First principle:

How long should his inpatient stay be? Could/should the patient be involved in key treatment decisions? In reality, are they? Whose decision?

Can patients be trusted to make the ‘best decision’? Can patients be helped to make the best decision? What about when they don’t?

Do we give patients and families the information they need to make the best, safest decisions possible? ‘The resident was totally inflexible. I wanted to know what the risks were so I could decide. He still wouldn’t tell me, even though he could see I was going to do it.’ Whose decision?

Shared decision-making cannot happen without patient and family centred care Respect & dignity Shared information Participation Collaboration Second principle:

What does patient centred care mean to patients and families? 1.How we are treated (respect & dignity) 2.What we are told (shared information) 3. How we are involved (participation) 4. How we give back (collaboration)

Participation is about patients and families being involved in their care and in decisions about it. Some people will want a lot of involvement, others will want less. Allowing them to choose the level is true patient centred participation. Patient centred participation

Care – and decisions – must be holistic Where does the family fit? What about the patient’s wider life circumstances? Quality of life? Values? Other health conditions? Third principle

Teaching shared decision- making to clinicians must start early Such a fundamental element of health care cannot easily be ‘added on’ to practice later It’s more than politeness or respect. It’s power-sharing Fourth principle

Thank you. Susan Biggar