Shared Decision Making

Shared decision making is the basis for consent and communication.  Over many years there has quite rightly been a drive away from paternalism in healthcare.  This has led to emphasis on shared decision making where the patient and practitioner both contribute to formulating the plan of action.

Paternalism still persiting

Despite many years of trying to influence change paternalism is still present in our healthcare system.  Dr Oliver Thompson demonstrated in his research that it is still present in osteopathy, which many osteopaths will not be surprised to learn:

 

There is still work to be done by osteopaths to move away from this paternalistic attitude.  Arguably all practitioners exhibit elements of the three attitudes at different times and in different aspects of their work.  Nevertheless it is important that through self-reflection, learning and working towards better practice that the predominant characteristic in osteopathy is ….  Evidence based practice demonstrates over and over again that manual medicine combined with empowering education and active treatments is the most effective treatment model.

What is shared decision making?

Shared decision making is where the patient takes an active role in planning their treatment.  The osteopath and patient together consider the treatment options and their risks and benefits available.  There is discussion of the choices available and reaching an agreed treatment plan.

Decisions made are related to what is important to the person.  Patients are to be supported and empowered to make informed choices.

If you are familiar with consent requirements you will be picking up on some keywords relating to consent – informed, treatment options, benefits and risks.  These are all essential components.

Shared decision making is a balance of the osteopath bringing their professional expertise against the patient’s needs and preferences, alongside evidence based practice.

What does Shared Decision Making look like in osteopathic practice?

One of the key facts to illicit from patients is their goals/expectations of treatment.  Most patients will state their goal to be out of pain but if encouraged they will be more specific.  Asking patients What their pain is preventing them from doing? Or phrased differently –  What did they used to do that they feel unable to do now?  You may find that your patient has just come along with a goal of wanting to have a full case history and examination and an understanding of what is wrong with them.  They may simply be happy to self-manage if appropriate.

These goals will often influence treatment decisions.  For example, they may introduce time constraints such as needing to be fit for a holiday or special occasion.

Patients may have come with expectations of what treatment will involve and how quickly they will get better.  The practitioner can educate them about what treatment is on offer and realistic expectations of outcomes.

Patients have the right to choose treatment modalities that are used – HVT, exercise, acupuncture, mobilisation etc.  Practitioners can inform of the benefits and risks of each treatment for that patient.

Patients also need to be informed about other treatment options – analgesia, scans, surgical options, other appropriate treatment modalities etc.  It is also important to discuss what would happen if they did nothing.

This is an ongoing process as at each treatment session progress is reviewed and the treatment plan is modified as appropriate following input from both the practitioner and patient.  The ultimate decision is what treatment to have and how it should proceed with both practitioner and patient working together for the best agreed outcomes.

Many practitioners may already be utilising shared discussion making in practice.  An interesting CPD exercise could be to set aside time with a colleague to work through a case.  You could discuss where shared decision making is demonstrated and opportunities for further shared decisions.  It can be a really interesting exercise to look at the process behind your consultations and treatments, it is often surprising how much good practice is already integrated.  You could use this exercise to identify areas for personal development within your patient interactions.

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