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Involving patients in treatment decisions

Key Slides. Involving patients in treatment decisions. Shared decision-making. ‘a decision making process jointly shared by patients and their healthcare provider’ Legare F, et al. Cochrane Database Syst Rev 2008;(3) 2.

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Involving patients in treatment decisions

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  1. Key Slides Involving patients in treatment decisions

  2. Shared decision-making ‘a decision making process jointly shared by patients and their healthcare provider’ Legare F, et al. Cochrane Database Syst Rev 2008;(3) 2

  3. Factors affecting a consultation • Healthcare professional-patient relationship - Previous consultations - Problem under discussion • Consultation skills • Trust Makoul G, et al. Patient Educ Couns 2006; 60(3): 301-312. 3

  4. Open-ended questions • Invite an extended response from the patient • Cannot usually be answered by a yes/no response • Do not assume a particular response from the patient • ‘Tell me some more about that’ • ‘How do you feel about…’ • ‘Describe what it’s like when…’ 4

  5. Patient preferences about treatment decisions Cox K, et al, Br J Gen Pract 2007; 57(543):777-784 5

  6. Patient misconceptions about medicines • Effects of medicine or disease? • Information sources e.g. internet, other people • Fear of dependency and tolerance • Health beliefs Pound P, et al. Soc Sci Med 2005; 61(1):133-155 6

  7. A patient must not be assumed to lack capacity to make a decision solely because of: Age Disability Appearance Behaviour Medical condition (including mental illness) Their beliefs Apparent inability to communicate Making a decision that a healthcare professional disagrees with Mental capacity World Health Organization (WHO) . Adherence to long-term therapies; evidence for action. 2003. 7

  8. NICE Clinical Guideline CG76 Medicines Adherence: involving patients in decisions about prescribed medicines and supporting adherence P57

  9. ‘Acceptors’: ‘Passive’ coerced into taking e.g. care settings ‘Active’ may modify regimes to Minimise side effects Make regimen more acceptable ‘Resistors’: Worries about dependence Long-term harm Masking of symptoms ‘Acceptors’ and ‘Resistors 9

  10. Ways patients take medicines Patients wish to minimise their intake of medicines: • To decrease adverse effects and dependence • To make the regimen more acceptable • Financial reasons • According to symptoms • Using them strategically • Non-pharmacological treatments 10

  11. What will happen if they don’t take the medicine Non-pharmacological alternatives Reducing or stopping long-term medicines Fitting medicines into their routine Choosing between medicines Discussing minimising medicines 11

  12. What do patients want to know? Sideeffects? What does it do? How to take it? Dos and don’ts 12

  13. Inform the patient about… • The medicine • What it is • How to use it • Likely benefits • Adverse effects • What to do if you experience them • Missed doses • What to do • Further prescriptions • How to get them 13

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