Many patients do not expect to be asked for their opinion or to become active participants in the discussion. They are more used to the ‘traditional’ model of healthcare, in which a health professional explains their diagnosis, offers a recommendation for a treatment and then proceeds with a prescription
These are people who need support to:
- become more actively involved
- go into the consultation prepared to take part in decisions
- discuss options and to be consultants themselves as well as consulters.
The way in which a professional engages with them is of course crucial, but before the appointment even starts, there are tools available to help patients prepare.
Ask 3 Questions
The Ask 3 Questions campaign encourages patients to ask three simple questions when faced with a choice about their treatment:
- What are my options?
- What are the pros and cons for each option?
- What support is available to help me make a decision?
Use of posters in waiting rooms, leaflets sent with appointment letters, graphics embedded within patient information leaflets, animations on waiting room televisions all raise awareness of the 3 Questions.
These resources are not just a reminder of useful questions they could ask, but they also give patients the permission to ask for, and the signal to expect, a more shared conversation about their care and treatment.
It is important to make sure though that, having raised expectations in this way, the professional they then meet does not dash their hopes.
Unfortunately, within short appointment slots there is rarely time to discuss every detail of a condition or every worry a patient may have.
Agenda setting can help ensure that the conversation focuses on the priorities – of both the professional and the patient – so that the things that matter most are discussed and no one leaves feeling dissatisfied.
Patients are asked to briefly list all of their aims for the meeting and similarly the professional describes their objectives, then with some negotiation a plan is drawn up together of what can realistically be achieved.
It may be that there are other sources of information or support available to address some of the issues, or it can be agreed that they can wait for a future appointment. In this way, professionals can fulfil their duties and patients can satisfy their most pressing needs.
This simple process can be triggered by a question at the start of the meeting or it can be started before the appointment itself – with patients asked to consider while they wait what they would like to discuss and to prepare their priority list.
Even professionals who strongly support the ethos of shared decision making report that it can be difficult to put into practice in busy clinical settings or complex situations.
Motivational interviewing can help teams take a positive approach to care and can support the shared decision making process. It offers a set of principles and skills that can help health professionals communicate with their patients, both to engage them in the conversation generally and to help elicit their values and preferences in relation to a specific decision.
The Teach Back method is a useful way to confirm that the information you provide is being understood by getting people to ‘teach back’ what has been discussed and what they have been asked to do. This is more than saying ‘do you understand?’: it is a check of how you have explained things, not of patient comprehension. It is particularly useful with people who have lower levels of health literacy and could be a useful tool as part of a shared decision making conversation.