Communicating benefits and risks
Communicating benefits and risks

Shared Decision-Making
Shared decision-making (SDM) has become best practice throughout healthcare as the optimal approach to obtaining informed consent for treatment: SDM should be viewed also as good clinical practice. Five steps to shared decision-making have been described by Epstein et al:

Step 1: Understand the patient’s experience and expectations
Explore what they want from the visit, what they value as outcomes

Step 2: Build partnership
Show empathy
Outline and discuss the decisions to be made, explain that it will be joint decision-making

Step 3: Provide evidence including uncertainties
Explain risks and benefit
Present the information with positive and negative framing, and with visual aids
Discuss the information in context to the patient

Step 4: Present recommendations
Propose a course you think is reasonable

Step 5: Check for understanding and agreement
Ask if it makes sense, explore their understanding and reaction, and perhaps the need for more information

 Shared decision-making – the role of the chiropractor and patient
Treatment options and their associated risks, benefits, and alternatives should be clearly understood by the patient. Decisions about treatment should be patient-centred, and patient autonomy must be respected. Patients should be given adequate time to consider treatment options, and any relevant information that exists should be made available to them. Good shared-decision making requires practie so the more you go through the process, the better at it you should become.

The patient may have a preferred role in shared decision-making. They may wish to share the decision-making with someone e.g. their chiropractor, or a friend/ family member or decide for themselves, perhaps following a discussion with another person
 
Patients should be able to make choices about their treatment without undue pressure from others, and should have confidence in their decision. If it becomes apparent that this is not the case then it is advisable that the clinician delays active treatment.

References
 Epstein RM, Alper BS, Quill TE. Communicating Evidence for Participatory Decision Making. JAMA 2004:291(19);2359-2366

O’Connor, A. M., C. L. Bennett, et al. (2009). “Decision aids for people facing health treatment or screening decisions.” Cochrane Database Syst Rev(3): CD001431.

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