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Four Steps for Shared Decision Making: Home

PUPS - Four considerations for effective patient interactions

 

Geelong has the Cats.    Barwon Health has the PUPS ...
 

|  Patient  Centred  |  Understanding   |    Preferences  |  Shared Decisions   | 

This short practical guide, aimed at busy clinicians, covers the five domains outlined in
 
Safer Care Victoria's Partnering in Healthcare to help achieve Barwon Better Care


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  Patient centred. Consider your patient's needs and concerns ...

The human touch - in the form of a smile, empathy, taking some extra time to talk - can have a huge effect on a patient's experience  

"Be kind whenever possible. It is always possible ..." Dalai Lama

 

Families and carers  Involving and supporting families and carers leads to a better patient experience. They provide emotional and practical support both during care and after discharge, as well as potentially providing useful insights for clinicians. If appropriate, they can be included in any shared decision making

Physical needs  Focus on alleviating pain, providing assistance with any daily living activities and making the surrounds and environment as pleasant, practical and safe as possible

Emotional needs  Focus on reassuring patients about anxiety over treatments and outcomes, impacts on their family, keeping them informed about their clinical progress, any financial stresses and important points raised in the What Matters to Me preferences section.

Get input from those using your service. No one understands the patient experience better than patients themselves. Either do this informally by talking to your patients and carers or request a Consumer Representative to get this end user input and improve your service. 

Resources:

      BH Person Centred Foundations  (GROW module - login with your computer login)
      Patient Centred Communication including Shared Decision Making  (GROW module - login with your computer login)
      Empathy (short video from the Cleveland Clinic)
      BH iValidate  (GROW modules - in depth 1 or 2 day patient-centred communication training sessions)
      PACE  (Patient and Care Escalation, "Our patient’s and their families know themselves and their loved one best")
      Carer Toolkit  (useful information for anyone providing care to another)
      Geelong Community Directory / Infoxchange  (find contact details for many health support organisations)


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  Understanding. Communicate so your patient understands ... 

Consider your patient's understanding of communications (health literacy)

Listen   Patients (and their families & carers) know their own health condition  better than anyone. Giving them the time - not interrupting too quickly or too often - can be very beneficial on both sides, both clinically and emotionally 

Teach-Back  This is a useful way to confirm that patient understands the the information you have provided. To do it, ask patients to 'teach back' to you what has been discussed or demonstrated. This is more than just saying 'do you understand?'. It's also important to ask in such as way that the consumer doesn't feel like they are being tested

Chunk and Check  This can be done with teach-back. Chunking means breaking up the information you are giving to consumers into smaller sizes and checking for understanding along the way using teach-back rather than only at the end

Simple language  Avoid jargon, health terminology, acronyms etc and use plain simple to understand language

Use pictures  Some concepts can be difficult to explain so use pictures, diagrams, models etc where relevant

Universal Precautions  60% of Australians have low health literacy and you can't always tell which patients fall into this category. Assuming that patients may not understand the information you provide is known as the universal precautions approach

Language and cultural differences  These complicate an already difficult situation for patients

Developing written information that will be seen by consumers?  Submit it to WISE (appointment letters, patient handouts, websites etc)

Resources:

      What the Heck is Teach-Back?  (short YouTube video)
      Health Literacy for Clinicians  (infographic, good for the poster board)
      Health Literacy for Clinicians II  (background information / useful infographic)
      Health Literacy (Barwon Health)
      Populations at Risk at Barwon Health (ATSI / Culturally + Linguistically Diverse / Older people)
      Watch a video and take the quiz ...
      Patient Handouts  (easy to understand patient-level information)
      Multimedia Resources  (for images, diagrams, videos etc)
      Barwon Health Language Services  (onsite only. for interpreters, translators, telehealth)
      Health Translations  (patient level information in many languages)
      Multicultural Resources  (e.g. see Cultural Perspectives resource in right hand box)  
      Cue Cards  (graphics to illustrate many common concepts / available in many languages)


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  Preferences. Assess your patient's values and preferences ...

Take into account what matters most to your patient .

Resources:

      What Matters to Me Today form (PDF).
         Use this form to record what matters to your patient, and staff actions taken in response to this
         Use this form to record family and carer questions and comments
         Use this form to record whether needs are being met & patient satisfaction on a daily basis

      Consumer Enablement  (short video from the Agency for Clinical Innovation)
      Populations at Risk at Barwon Health (ATSI / Culturally + Linguistically Diverse / Older people)  
      Cultural & Multilingual Patient Information Resources

      Health Talk Australia & Health Talk International (Videos of patients and carers talking about what it is really like to have a condition) 
      BH Advanced Care Planning  (includes a link to MyValues where patient's can record their end of life preferences)


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  Shared decisions making. Help your patient explore and compare treatment options ...


When applicable, communicate that a clinical choice exists and invite your patient to be involved in decisions (some patients will not want to be involved). For those that do, discuss the options, including benefits and harms and the patients preferences

Ask-Tell-Ask    Elicit relevant information (see ICE below) from patients first before giving your information and follow up by asking them again. Are you the one doing all the talking?

ICE    What can be useful questions to ask? ICE stands for ideas, concerns, expectations and can be a good acronym to keep in mind. Open ended questions are best

Decision Aids    These can be useful to use in consultation with your patient to help structure the discussion, provide visuals etc

Experts    We are the experts in clinical matters while patients are the experts in their lives. The combined input of these two experts can provide the best outcomes

Document    Record salient points in your units care documentation. This help other staff and also reduces the patient having to repeatedly given their side of the story

Myths    There are a number of myths about shared decision making. See the video in the Resources section below. Of course every clinical encounter has it's own characteristics and so must be tailored accordingly

   Resources:

      Ottawa List of Patient Decision Aids  (A-Z directory of conditions, with risks / benefits for different treatment options). 
      EIDO  (onsite only. primarily for easy to understand procedure information with a section at the top for patient questions and comments. 
      Available in large print, giant print, screen reader format also)
      Shared Decision Making at the Mayo Clinic  (short video)
      Calgary Cambridge Guide
      Short videos from NSQHS:
         What is Shared Decision Making
         Myths about Shared Decision Making
         Decision Aids
      Patient Centred Communication including Shared Decision Making  (GROW module - login with your computer login)      
      BH iValidate  (GROW modules - in depth 1 or 2 day patient-centred communication training sessions)
      Choosing Wisely Recommendations   ("Tests, treatments, and procedures for healthcare providers and consumers to question")
      Patient Handouts


Something not right? Other useful resources? Important considerations missed? Send a feedback email