A guide to sharing your consultation

Empowering patients to take part in the decision making process
Something that is increasingly more important within consultations is the idea of shared decision making and a shared agenda. Most doctors, when asked if they share these aspects of a consultation, will say that they do, however, in reality, that isn’t always the case.

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

When an agenda is shared, then both the patient and the medical professional will give each other time to achieve their objectives.

Patients feel respected

If a patient feels their agenda is being taken into consideration, then they will feel respected.

Builds lasting rapport

When a doctor listens to and works with a patients agenda, a patient is much more likely to engage with that doctor in the future.

Builds trust in the doctor

If a doctor shows they will listen to a patient and work with their agenda, then it would be hard not to trust that doctor more than a doctor who doesn’t listen to or take into account the patient agenda.

Leads to a smoother consultation

When there is one shared agenda, rather than two opposing agendas, potential frustrations for both the consulter and the patient can be eliminated.

Benefits of a shared agenda

Patients feel empowered

Patients will feel a sense of ownership of their treatment and recovery when they are more involved in the process.

Improves compliance with management plans

When a patient is given a choice about their management plan, then they are much more likely to comply with it rather than just blindly following the decision of a doctor.

More likely to retain information

When given a choice about an issue and are able to weigh up the risks and rewaeds, people are more likely to remember the pros and cons and other aspects of a management plan.
Taking all this into account, it is clear to see that including sharing as an integral part of a consultation can be very helpful to the patient. So why don’t more clinicians frequently incorporate sharing into their consultations and how can this be improved?

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To find out, first, let’s talk about the idea of a shared agenda. Sharing the agenda is something most clinicians do instinctually, to varying degrees of success.
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.
Now, moving on to shared decision making – as mentioned earlier, often doctors feel they are already sharing their decision making, albeit sometimes unsuccessfully, and so are unaware they may need to try different strategies. Phrases to watch out for are those with the word “I” in them, such as I think we need to…”, “What I’m going to do is…” “I’m going to put you on this treatment…” and so on. If you find that these are part of your regular vocabulary, then it may be an idea to switch things around and see if you notice some benefit. Adding sharing statements into the consultation will give your patient permission to voice their thoughts. To make it even more explicitly clear that they have the option to state their opinion, preface a suggested management option with the sharing phase. “How would you feel if we tried…”, “Would you be willing to…”, or “What are your thoughts on…” are all good examples of sharing statements that will help empower the patient to take ownership of their treatment.

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.

So, in summary, by making sure the patient is as involved as possible throughout the consultation clinicians can not only make their day to day work less stressful for them but also benefit patients by allowing them to have an active say in how they are treated and so increase satisfaction, rapport, engagement and compliance.

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