A quick exercise to help your shared decision-making

10 Minutes to Better Patient Communication

Improve your shared decision-making (SDM), no matter how you do it.

Just like it says on the label, today’s episode is a quick exercise to help you improve your shared decision-making, no matter how you do shared decision-making.

Hi everybody, I'm Dr. Anne Marie Liebel, and this is 10 Minutes to Better Patient Communication from Health Communication Partners, ranked #20 of Top 100 Podcasts in Social Sciences by Goodpods. Our online course, Equitable Patient Education, promotes high-quality clinical practice by helping prevent avoidable errors. Learners say, There's a lot of eye-opening information I hadn't considered before. For more information, you can visit healthcommunicationpartners.com or connect with me on Linked.

And I have to tell you, you are the most talented, cutting edgiest, best-looking audience in the podcast universe! You’re already great at what you do. What you want is more tools to address problems that you see, so you can move forward in a way that’s relevant to you and your situation. That’s what I support in this show. That’s what I support with my clients. And yes, you can work with me.

I had a physician give me a huge compliment and call me a “shared decision-making guru,” which meant a whole lot to me as an educator too. Ever since medicine started shifting away from its paternalistic model toward more patient-centered care, shared decision-making has been talked about.

So here’s the point where I go to a couple definitions. One of them is from the Clinical Journal of Oncology Nursing that says shared decision-making is quote, “A healthcare delivery model that mandates patient-centered care for clinical practice.” The journal Patient Education and Counseling offers a slightly different view, and says that shared decision-making is related to “an ethical imperative to respect the agency of individuals, offer information, collaborate, and support deliberation when difficult decisions arise.”

I had one physician tell me a story of when she was told to “go do a shared decision-making” with a patient. As you might suspect, things are not often quite that straightforward.

An article in the journal Social Science and Medicine says that shared decision-making kind of suffers from a problem of not reflecting well how decisions are typically made by real people in the real world. The authors say, “This model rarely incorporates what is known about decision-making, or makes room for the various ways that decisions are made in the real world.”

For example, they say that shared decision-making policies and guidelines “do not adequately support clinicians in considering the needs and experiences of individual patients, nor in attending to aspects of the patient-clinician relationship or the healthcare environment that may impact decision-making.” They go on to say, “Healthcare systems are not designed to support clinician-patient collaborations.” They point out, “Patients are influenced by their changing circumstances and experiences, but shared decision-making does not typically acknowledge these contextual and dynamic processes.” They further go on that “clinicians’ attitudes, experiences, and behaviors also influence the decision-making process, but clinicians are inadequately prepared to deal with the impact of these factors when engaging their patients in shared decision-making.”

So, maybe you do shared decision-making because of the ethical imperative. Or because you were told to. Or because of the benefits you want to get. Whatever your reason, you know, it’s important and you do it and that makes me a fan of yours. You want to help patients understand something important. So you’re educating them, communicating with them. Maybe you’re handing them something to read.

In those moments, your patient is going to try to make some sense of what you’re saying or what you’re handing them. This sense -making is where I want to park it for a moment because it is a complex process we’re all involved in all the time, as living, breathing human beings.

Now the article I just referenced emphasized that what shared decision-making is missing is understanding how real people make decisions in the real world, and the importance of contextual factors on us. So I want to take you through an exercise to kind of help remedy that. To help you maybe get a different perspective, or deepen your appreciation of some of what’s involved when we make sense of something someone is telling us, or something we’re reading or writing.

This is to help you be aware of and deal with the impact of context in your shared decision-making, so you can get the benefits.

What are some of those benefits, you ask? Better patient-provider communication, strengthening the patient-provider relationship, patients’ greater satisfaction with their care and engagement in that care, a greater sense that patients have of control over their health decisions, an improved understanding of their condition, and overall better outcomes.

So let’s get to this exercise, a bit of a thought experiment. Play along with me, won’t you?

I want you to think of the last time you made up or used a grocery list for your food shopping. We’re going to unpack this very mundane text. And you’ll see how it’s not just the words on the page that matter, but contextual factors that influence how we make sense of those words.

So think about that. Maybe you’re writing a list. While you’re writing down things on that list, you’re doing it in a specific situation that has an impact on what you write. For example, how much of a rush you are in. What budget you’ve got. Maybe you’re trying to keep a handle on your feelings about food shopping, or a budget, or both. You’re thinking about who’s at home. Who’s eating what? How quickly? What’s in the fridge? What’s in the closet? What’s on sale? What’s easiest? What’s new? What do you have time to make? Maybe there’s someone else whose responsibility it is to take care of meals. Maybe on different days this week. What do they make?

Thoughts like these and more come into play when you’re deliberating over what to write on that shopping list.

Or maybe you didn’t write the list, it’s just your job to do the shopping. When you’re reading that list, stood at the store maybe, you’re not just reading the list, you’re also interpreting the meaning of what’s on the list. And you might go through some similar processes. Thinking about time, all the other things you have to do today after this shop. Thinking about money. Also thinking about the person who wrote the list. What do they tend to always put on the list? What do they tend to always forget from the list? How much you do or don’t agree with what’s on the list. The conversations you might have later around what you did and didn’t get from the list. And what all of this has to do with the week stretching ahead of you, who’s in charge of the budget and grocery shopping and cooking to begin with.

Well, let’s just think for a moment about what contextual factors came into play: Time, money, other people, emotions, past experiences, values, power dynamics, priorities. They came into play, influencing your thoughts and decisions and ultimately your actions about what you put on the list, or bought from the list, how you read the list.

We’re making connections to a lot more than just words in the here and now and your patients are no different. Every day, people encounter and interpret information related to their health and health care. The vast majority of the time they’re not with you, but during shared decision making, they are. They’re interpreting and making sense of what you’re sharing with them by making countless connections like those that we just talked about, other factors: people who may or may not be in the room, past experiences, emotions, values, power dynamics, priorities.

These make a difference to the kind of sense we make of what we hear and read.

This short exercise was to help your awareness and appreciation for the role of contextual factors in our thoughts and actions. I hope it also strengthens your respect for the mental calculus you and your patients are going through in shared decision-making. This “real-world” example can also help you avoid what those authors called “shared decision-making’s problem” with the way decisions are made in the real world.

If you’d like more help with this our course Equitable Patient Education helps you avoid obstacles in six common educational scenarios, so you can reduce barriers to access. For more information on this visit healthcommunicationpartners.com or connect with me on Linked. I’m Dr. Anne Marie Liebel. This has been 10 Minutes to Better Patient Communication from Health Communication Partners. Audio Engineering and Music by Joe Liebel. Additional music from Alexis Rounds.

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