A guide to sharing your consultationEmpowering patients to take part in the decision making process
Before we go into why that is and how to improve sharing within the consultation, lets first talk about some of the benefits of a shared agenda and sharing the decision-making process.
Benefits of a shared agenda
Everyone achieves what they wanted to
Patients feel respected
Builds lasting rapport
Builds trust in the doctor
Leads to a smoother consultation
Benefits of a shared agenda
Patients feel empowered
Improves compliance with management plans
More likely to retain information
Before we can understand best practices for a shared agenda, it is important to discuss what can stop people from achieving a beneficial shared agenda. Simply eliciting someone’s ideas, concerns and expectations, (ICE) does not make an agenda shared. That ICE needs to be incorporated into the consultation in a tangible way.
A good strategy for this is to summerise back to the patient what they have told you, what their concerns are and then screen for further concerns. The benefit of this is that the patient will feel reassured that the doctor is taking them seriously but also that, by screening for further concerns, the doctor can feel reassured that they have the full picture.
It can be useful for the doctor to also share their own agenda points and give a context for them. These may very well come directly from the patient’s story. There will likely be points they have raised and cues that are given that will want to be explored and addressed and these can be shared this with them.
Building from this shared understanding, there will now be clearly defined points that can be used to form a shared agenda. The rest of the consultation should move forward smoothly with both parties giving each other the opportunity to achieve what they need.
Other times, there is a perception that patients have no interest in being involved in the process. While this is sometimes true, it is an important thing to explore. There can be many reasons this might seem the case, when in fact, rather than being uninterested in participating in a shared decision-making process, a patient may simply feel unable to take part. Patients can feel they do not have the right to take part in the process, potentially disagreeing with the doctor. A perception that can unconsciously be reinforced by the doctor when they do not take the patient agenda into consideration. This is particularly true with older patients who are more accustomed to be subservient to a doctor. However, by involving them in the consultation and having more of a two-way conversation a patient will feel more able to give their opinion. This can be done by exploring their ICE, summarising it back to them and addressing their agenda, and so empowering the patient to take a more active role in the consultation.
Another reason doctors may feel patients have a lack of interest in a shared plan can be that, as a layman, they do not feel equipped to make a valid decision. Without giving the patient an understanding of the pros and cons of the different options, how can they make an informed decision? It is important to give different options a context. While saying, “we could do A or B, what would you prefer”, is giving the patient choices and therefore sharing the management plan, it is far more helpful to say “we could do A, the benefits being this but has the following risks…” and so forth. This way the patient can feel empowered to make an informed decision.
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