Key Considerations During the Design and Pilot Stage
Tip:Remember that shared decision-making programs can differ within the same organization. Different groups will pick the paths that best meet the needs of their patients. For example: • Orthopedists might have patients review a decision aid prior to their surgical consultation. • Primary care providers may help patients decide about screening tests during their visit.
The precise moments to offer shared decision-makingExamples: Upon delivering biopsy results, when symptoms cause a certain level of distress, before and during a surgical consultation, etc.
All available options, including those that seem less than idealTry to avoid thinking in terms or what is “best” for the patient—focus on what is available. For colon cancer screening, is flexible sigmoidoscopy a realistic option? FIT testing?
Exactly what information patients should walk away withTeam members may interpret medical evidence differently. Work together to distinguish facts from opinions, then decide what medical information patients need in order to make decisions. Narrow those key pieces of knowledge: How likely is this intervention to help? How likely are we to find cancer during your colonoscopy?
Vision for the new workflowCompare the new workflow to the existing workflow. Where are the similarities and differences? Your team may discover that the new model isn’t too different from the old one, which may make implementation easier.
Strategies for effectively communicating information to patientsThis may include clear communication strategies (such as teach-back), conversation scripts/prompts, established decision aids, specific patient education materials, etc. Depending on the framework you choose, you might employ shared decision-making resources before, during or after a clinical encounter. Some practices will want a standardized approach; others will craft a tailored approach depending on the decision to be made, clinical workflow, framework, philosophy, and available resources.
Accountability loopWho will train pilot participants, monitor implementation, and assess results? Who is accountable for process improvement? Do you have a “close the loop” strategy to ensure that the patient is supported all the way through the process?
Patient feedback is vitalInclude feedback on your shared decision-making project from your patient advisory committee, or ask 1–2 patients to participate in your workgroup.
Tip:Use this PDSA cycle tool to help speed up your design process: >> View the IHI Model for Improvement