Subject: Friend, 3 Best Practices for Shared Decision-Making in OSCEs

3 Best Practices for Shared Decision-Making in Healthcare

Decision-Making is one of the core competencies being assessed in OSCE exams. That is why it is important to understand what is decision-making and how to practice it.

In an article posted in Patient Engagement HIT by Sara Heath on September 17, 2017, delivering meaningful patient engagement requires that patients play a key and active role in their own healthcare. As a part of that effort, healthcare professionals are increasingly looking to integrate shared decision-making into patient engagement strategies.

“Shared decision making is a key component of patient-centered health care,” according to the ONC. “It is a process in which clinicians and patients work together to make decisions and select tests, treatments and care plans based on clinical evidence that balances risks and expected outcomes with patient preferences and values.”

“Researchers and clinicians should be motivated to find ways to engage patients on the ethical imperative that many patients prefer to be more engaged in some way, shape, or form; patients have better experiences when they are engaged, and engagement improves health outcomes,” Blumenthal-Barby, Baylor College of Medicine researcher, said in a March 2017 paper. “Reminding ourselves of those goals can help further the work of patient engagement.”

A research team led by Ming Tai-Seale, PhD, MPH, also acknowledged those clinical benefits, while adding that shared decision-making has a moral component. “Shared decision making is not only conducive to reducing information asymmetry but also is ethically the right thing to do,” Tai-Seale and colleagues previously wrote in Health Affairs. “Systematic reviews of the preconditions for improving health care delivery have emphasized the importance of shared decision making as a mediator and moderator of health care quality.”

Implementing a valuable and patient-centered shared decision-making strategy will hinge on strong patient outreach. Clinicians working to improve shared decision-making should leverage patient education techniques, assess patient cultural and personal preferences, and involve patient family members and caregivers into treatment decisions.

1. STRONG PATIENT EDUCATION, DECISION AIDS

Patients cannot effectively participate in shared decision-making if they do not fully understand their current health condition, all of the treatment options, and the potential side effects of each treatment option.

Patient teach back, for example, helps the provider deliver health information and ensure the patient has retained that information. The technique calls for providers to first teach the patient about various pertinent health concepts. From there, clinicians should ask patients to repeat that information back to them in the patients’ own words.

Patient teach back accomplishes two goals;

First, it requires the patient to synthesize information so that he/she can describe it in a way that makes sense to him/her, promoting information retention.

Second, it allows the provider to assess where there are lapses in understanding. If the patient recalls information incorrectly, the provider knows to go back and review that fact with him/her.

Decision aids offer an understandable, comprehensive review of the patient’s condition and treatment options, and prompts his/her to think about how all of this will fit into his/her lifestyle needs and preferences, according to Peter Goldbach, MD, Chief Medical Officer at decision aid company Health Dialog.

“The patient is the expert on the patient, so the provider needs that information. The provider is the expert on the disease, so the patient needs that information,” Goldbach said in an interview with PatientEngagementHIT.com. “Together, they can do the best job in terms of finding an approach to a clinical problem.”

2. UNDERSTANDING PATIENT CULTURAL AND PERSONAL PREFERENCES

Clinicians must also understand what the patient wants out of his/her care and interactions with providers. Assessing personal preferences should begin with how big of a role the patient wants to play in her care.

Patients should be asked what role they want to play or what model they prefer,” Baylor’s Blumenthal-Barby advised.

Cultural differences can have a significant impact on patient preferences for care. Some cultures might value the clinician has the primary decision-maker. These patients may be less likely to want to engage in shared decision-making.

Clinicians should assess these values at the start of the care process, Blumenthal-Barby explained.

Providers should also reframe their idea of making treatment decisions. Making a healthcare decision is not always about what the provider wants to do, but about what will complement a patient’s life circumstances.

Providers need to uncover the motivating factors that drive a patient care decision rather than make assumptions.

3. ENGAGING FAMILY AND CAREGIVERS

As with many aspects of patient care, involving family members and caregivers is important. Patients lean on their loved ones during times of uncertainty and when their health is ailing. Involving family members in the care decision-making process is a key strategy to supporting patient care and driving a positive experience.

The path to better family engagement in shared decision-making looks much like shared decision-making with individual patients. Providers need to offer ample education on the matter at hand and support a patient- and family-centered approach.

Clinicians also need to understand patient preferences for family involvement. In some cases, patients may not want high levels of family engagement.

Providers may also encounter families and patients with contrasting wishes. In these cases, clinicians must recognize that the patient is fundamentally in charge.

 

As you see, shared decision-making is key to driving patient-centered care. Clinicians can ensure treatment adheres to patient wishes and ideally encourages better patient engagement by allowing patients a place at the decision-making table.

The OSCEhome Systematic Approach to the patient interview and OSCEs, which is been used successfully by over 4000 OSCE candidates since 2005, carefully incorporated these three decision-making principles; strong patient education and decision aids, Understanding patient cultural and personal preferences, and engaging family and caregivers in its flowchart in a time-efficient manner.

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Dr Al Imari.
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