Shared Decision Making (SDM) Made Easy! Available online at h-p://nerdlmps.wordpress.com/ created by Ricky Turgeon, BSc(Pharm), ACPR, PharmD updated 4/7/2015 1. Determine if decision appropriate for SDM 2. Offer choice 3. Provide opRons 4. Elicit paRent preferences & decision 4step process to SDM (adapted from J Gen Intern Med 2012;27:13617 and Gut 2012;61:45965) A decision is appropriate for SDM when: 1. There is no clear best opRon 2. Something is at stake 3. Choice is preferencesensiRve Offering choice: 1. Summarize problem requiring management 2. JusRfy paRent’s role in choice (e.g. sensiRve to preferences/goals, benefit/harm uncertainRes) 3. Assess reacRon 4. Defer premature closure (i.e. paRents responding with “what would you do?”) by offering to describe opRons Providing opRons: 1. Assess preconcepRons and prior knowledge 2. Use an available decision aid 3. List ALL opRons 4. Describe opRons • Highlight clear important differences • Use evidencebased risk communicaAon 5. Summarize using teachback method Sources of decision aids: • O-awa Hospital Research InsRtute: decisionaid.ohri.ca/ (appraised using quality criteria checklist) • OpRon Grid: opRongrid.org/opRongrids.php • Mayo Clinic: shareddecisions.mayoclinic.org/decisionaidinformaRon/decisionaidsforchronicdisease/ Evidencebased risk communicaRon: (adapted from Ann Intern Med 2014;161:27080) 1. Avoid qualitaRve terms (e.g. common, very rare); QUANTIFY 2. Compare absolute risk with and without treatment 3. Describe risk using % or natural frequency (i.e. 1 in 100 or 1 in 10,000) • Avoid use of NNT/NNH • Use common denominator to describe benefits and risks 4. Use visual aids (e.g. “smiley face” graphs or bar graphs) 5. Contextualize • Describe consequences of outcomes • Compare risk to frequency of other events (e.g. car crash or being struck by lightning) Coming to a decision: 1. Focus on preferences (“What ma-ers most to you?”) 2. Elicit a preference about available opRons 3. Move to a decision • “Do you have any quesRons?” • “Are you ready to decide?” • Be prepared to defer if choice not RmesensiRve 4. Offer future review and reconsideraRon when possible

Shared’Decision’Making’(SDM)’Made’Easy!’ · 7/4/2015 · Shared’Decision’Making’(SDM)’Made’Easy!’ Available(online(at hp://nerdlmps.wordpress.com/ (8(created(by(Ricky(Turgeon,(BSc(Pharm),(ACPR,(PharmD

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Shared Decision Making (SDM) Made Easy!

Available online at h-p://nerdlmps.wordpress.com/ -‐ created by Ricky Turgeon, BSc(Pharm), ACPR, PharmD -‐ updated 4/7/2015

1. Determine if decision

appropriate for SDM

2. Offer choice 3. Provide opRons

4. Elicit paRent preferences &

decision

4-‐step process to SDM (adapted from J Gen Intern Med 2012;27:1361-‐7 and Gut 2012;61:459-‐65)

A decision is appropriate for SDM when: 1.  There is no clear best opRon 2.  Something is at stake 3.  Choice is preference-‐sensiRve

Offering choice: 1.  Summarize problem requiring management 2.  JusRfy paRent’s role in choice (e.g. sensiRve to

preferences/goals, benefit/harm uncertainRes) 3.  Assess reacRon 4.  Defer premature closure (i.e. paRents responding with

“what would you do?”) by offering to describe opRons

Providing opRons: 1.  Assess preconcepRons and prior knowledge 2.  Use an available decision aid 3.  List ALL opRons 4.  Describe opRons •  Highlight clear important differences •  Use evidence-‐based risk communicaAon

5.  Summarize using teach-‐back method

Sources of decision aids: •  O-awa Hospital Research InsRtute: decisionaid.ohri.ca/ (appraised using quality criteria checklist) •  OpRon Grid: opRongrid.org/opRongrids.php •  Mayo Clinic: shareddecisions.mayoclinic.org/decision-‐aid-‐informaRon/decision-‐aids-‐for-‐chronic-‐disease/

Evidence-‐based risk communicaRon: (adapted from Ann Intern Med 2014;161:270-‐80) 1.  Avoid qualitaRve terms (e.g. common, very rare); QUANTIFY 2.  Compare absolute risk with and without treatment 3.  Describe risk using % or natural frequency (i.e. 1 in 100 or 1 in 10,000)

• Avoid use of NNT/NNH • Use common denominator to describe benefits and risks

4.  Use visual aids (e.g. “smiley face” graphs or bar graphs) 5.  Contextualize

• Describe consequences of outcomes • Compare risk to frequency of other events (e.g. car crash or being struck by lightning)

Coming to a decision: 1.  Focus on preferences (“What ma-ers most to you?”) 2.  Elicit a preference about available opRons 3.  Move to a decision

•  “Do you have any quesRons?” •  “Are you ready to decide?” •  Be prepared to defer if choice not Rme-‐sensiRve

4.  Offer future review and reconsideraRon when possible