Managing TIME

  • No one wants to waste time. So how can clinicians optimize existing resources and infrastructure to introduce SDM? How can clinicians be certain that the best practices they introduce are effective and worth the time?

    Helpful Hints:

    • Step 1

      Test out new strategies with a handful of patients and provide feedback on the experience and outcomes with the team to assess if it’s worth formally introducing and training

    • Step 2

      Involve other members of the healthcare team to engage in and document on SDM

    • Step 3

      Employ some of the checklists, decision aids and, resources found in this Quick Guide for easy rollout

    • Step 4

      Use patient portals to support review of results and communication

    Key Elements of Knowledge Shared Decision Making

    1Step

    Ask ...and listen. Use motivational interviewing to identify issues

    Basic Principles of Motivational Interviewing:
    • understanding the reality of the participants situation
    • focusing on personalizing desire and reasons for change support
    • help others find ways to be successful that will work for them
    • don't push for change, don't provide information prematurely or without permission from the patient
    2Step

    PrioritizeExplore the patient's needs and expectations

    3Step

    Ask Identify barriers to shared desicion making

    Overcoming Provider-Centered Obstacles
    Provider-Centered Barriers
    Solutions
    • Insufficient comfort in
      experience
      Consider consultation or
      referral
    • Unfamiliar with
      case
      Review the record, schedule
      another visit
    • Limited access to resources
      Communicate limitations
    • Time constraints
      Refocus on achievable outcomes
    • Beliefs and values
      Transfer care
    • Unable to establish rapport
      Allow time, include other team members
    Overcoming Patient-Centered Obstacles
    Patient-Centered Barriers
    Solutions
    • Health literacy and numeracy
      Use plain language
    • Language
      Interpretive services
    • Perceptual (sight, hearing)
      Assistive devices
    • Cognitive limitations
      Involve surrogates
    • Emotional interference
      Identify strong emotions
    • Depression
      Identify and treat depression
    • Decision-making style
      Establish roles and preferences
    • Beliefs and values
      Ensure cultural competency
    • Knowledge gaps
      Attention to environment
    • Transmission
      (noise or physical distractions)
      Real-time education, homework, referral
    4Step

    Advice Allow time for discussion and consultation

    Give it Some Time
    Allow time for discussion and consultation
    • Peer (Group Visits)
      Team Members
    • Family Members
      Community Resources
    5Step

    Acknowledge Acknowledge the criteria upon which the decision will be made

    Agree on what's important to the individual
    • Evidence
      Power
    • Values
      Expectations
    6Step

    Assist Present the options: what are the choices?

    Weigh the Alternatives
    • Pros
      Cons
      Risks
      Benefits
      Likes
      Dislikes
      Achievable
      Challenging
      Short-term
      Long-term
    Facilitate the Process
    • Offer Patient-Decision-Aid (PDAs) Tools

      Paper and Pencil (cards, worksheet)

      Web-based tools

      Discussion with others

    7Step

    Make the Decision

    8Step

    Evaluate Revisit the process if concerns arise

    Evaluate the Process with the Patient
    • Expectations
      Experience
    • Satisfaction

    Shared Decision Making Algorithm

  • Educating patients on how to use online resources actually saves the physician time

    - George Simon, MD